Thyroid Cancer Reconsidered: Treatment Is Not Mandatory

thyroid cancer

A U.S. study has found out that thyroid cancer cases have tripled since 1975, but it also determined researchers to reconsider this disease and state that treatment might not be mandatory for all people diagnosed. The findings surface the fact that the tripling of this condition is related to over diagnosis and aggressive treatment of tumors too small to cause harm. Other research reveals the fact that certain cancers of lung, breast, prostate and thyroid could never become deadly, because they grow slowly and too much screening generally leads to overtreatment. Therefore, thyroid cancer may not be as harmful as people believe and some doctors state.

Doctor Gilbert Welch, co-author of the study which aims at reconsidering thyroid cancer questions whether treatment is mandatory for all cancers and emphasizes the fact that 85 percent of the people diagnosed who go through a thyroid removal surgery may not need such an aggressive solution. The treatment for this kind of disease usually involves taking out most or all of the thyroid gland, but complications could affect the voice and the patient will have to take thyroid replacement medication on a daily basis, for the rest of his or her life.

The study which clearly shows that even though the cases of thyroid cancer have tripled, death rates remained at 0.5 per 100,000 could mean that this condition should be reconsidered, because aggressive treatment might not be mandatory. Welch also pinpointed the fact that patients should also stop assuming that if they have cancer, treatment is essential.

“It’s a challenging rethinking,” Welch said.

The study published online last Thursday in JAMA Otolaryngology allowed Welch and Dartmouth colleague Doctor Louise Davies to analyze government data from 1975 to 2009; the findings show that 14 people out of 100,000 have thyroid cancer and even though it means that there is an ongoing epidemic in the United States, the results could be influenced by better detection methods which lead to over diagnosis.

Doctor Brian Burkey, a Cleveland Clinic head and neck cancer specialist considers that physicians should address this issue differently, namely “openly share with patients the uncertainty surrounding small thyroid cancers.” Explaining that it cannot be known whether the tumors are harmful or not is also necessary in order to allow people make better informed decisions and even opt for monitoring instead of treatment.

Alternatives

Since Doctor Welch stated that thyroid cancer should be reconsidered because treatment might not be mandatory in all cases, he also proposed an alternative, namely to monitor the growth of the modules before resorting to biopsy.

“Growth is a pretty important part of lung cancer screening for small lesions that look like cancer,” Welch said. “We’re not going to stick needles in them until they show some growth.”

Welch is even questioning whether doctors should palpate people’s necks at all, mentioning that “a watchful waiting, active surveillance” is essential in order to diagnose patients.

Secondary Conditions

Although thyroid cancer may not be harmful in all cases, a new analysis made by Melanie Goldfarb, M.D., and David Freyer, D.O. of the Keck School of Medicine of the University of Southern California shows that adolescents and young adults who have had an initial cancer can develop a thyroid condition which is 6.6 times more deadly than the primary cancer. Therefore, it is important to screen cancer survivors with ages between 15 to 39 in order to detect early signs of thyroid malignancy that can put their lives in danger.

Except for the secondary thyroid cancer, which is more harmful that the primary one, studies show that this condition should be reconsidered, because treatment is no longer mandatory and patients can choose to be monitored instead of treated.

By Gabriela Motroc

Sources

NPR
National Post
CBC News
Medical Xpress

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