Thyroid Cancer Overdiagnosis Leads to Unnecessary Surgeries

thyroid cancerSlow-growing tumors are reason for concern, but too often they result in the overdiagnosis of thyroid cancer, which leads to unnecessary surgeries. A new study shows that the number of people diagnosed with thyroid cancer has tripled since 1975 and the common approach of treatment is aggressive.

Dr. Gilbert Welch from Dartmouth’s Geisel School of Medicine authored the study and says that thyroid cancer is heavily overdiagnosed. He and his colleagues found that cases of thyroid cancer doubled from 1975 to 2006, yet the number of people dying from it did not change. If more cases were being identified and treated, more lives would have been save and the death rate would have gone down. By 2009, they found, the number of cases had tripled. Death rates still did not go down.

Women were four times more likely to be overdiagnosed than men, according to the study that was published on Thursday in JAMA Otolaryngology – Head and Neck Surgery. They used Federal government data to study diagnosis patterns. They also used the National Vital Statistics System to review death rates associated with thyroid cancer. They found an epidemic of overdiagnosis, but not an epidemic of the cancer.

Papillary thyroid cancer is likely the issue with overdiagnosis and unnecessary surgeries. It is a slow-growing cancer that measures less than two centimeters. It does not require immediate and aggressive treatment. Regardless, treatment of the slow-growing cancer often includes surgery to remove the bump.

Manual exams are not definitive. An ultrasound may show the bump and that usually leads to a biopsy to test it. Then doctors usually recommend surgery to remove it. In fact, 85 percent of people diagnosed with thyroid cancer end up having surgery. The study shows that the surgery is not necessary and the way people view this type of cancer needs to change. The important thing to note is the growth rate of the cancer.

Welch recommends “watchful waiting,” rather than quick and aggressive treatment. He says that people are undergoing unnecessary surgeries to remove thyroid cancer that would not have grown or caused them any harm in the future.

Dr. Brian Burkey from the Cleveland Center states that surgery is the only treatment plan for those with papillary thyroid cancer. He agrees with Welch, however, that evidence suggests the alternative is to wait to see if the cancer grows. Although he expects the same rate of surgeries to continue until clinical studies show that thyroid cancers do not result in early death.

The thyroid gland helps regulate metabolism. The hormones it releases are necessary and once the gland is removed, patients must take medication for the rest of their lives to replace the hormones.

The study shows a need for doctors to discuss all options with patients who have been diagnosed with thyroid cancer. Certainly, there are some cases in which surgery is a valid option, but it is not always necessary with slow-growing cancers. People also need to be aware of this and be willing to get past the fear of cancer and wait to see it the tumor grows before rushing to have it removed.

By Tracy Rose

Sources:

The Oncology Report
Philly
NPR

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