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Low-risk tumor imaging leads to increased thyroid cancer rates
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The increase in the number of new cases of thyroid cancer diagnosed during the past decade can be attributed to low-risk asymptomatic cancers, according to recent study findings published in Thyroid.
According to the researchers, over the last decade half of the thyroid cancer cases were diagnosed in people without symptoms of thyroid disease.
“We are spotting more cancers, but they are cancers that are not likely to cause harm,” Juan P. Brito, MBBS, assistant professor of medicine at the Mayo Clinic in Rochester, Minnesota, said in a press release. “Their treatment, however, is likely to cause harm, as most thyroid cancers are treated by surgically removing all or part of the thyroid gland. This is a risky procedure that can damage a patient’s vocal cords or leave them with lifelong calcium deficiencies.”
Juan P. Brito
Brito and colleagues evaluated 476 men and women who were diagnosed with thyroid cancer in Olmstead County, Minnesota, between 1935 and 1999 (n = 263) and 2000 to 2012 (n = 213) to determine the incidence of thyroid cancer, disease-specific mortality and method of diagnosis. Mechanism of detection of clinically occult tumors also was evaluated from 2000 to 2012.
“There is no benefit in routinely looking for thyroid cancer lesions in asymptomatic patients,” Brito told Endocrine Today. “Similarly, clinicians should not routinely order a thyroid ultrasound in patients with abnormal thyroid function tests.”
Researchers found an increase in age-adjusted incidence for thyroid cancer — 7.1 per 100,000 person-years from 1990 to 1999 to 13.7 per 100,000 person years from 2000 to 2012. Between 1935 and 2012, 2.3% of patients died, but no significant change was found for age-adjusted specific disease mortality during that period.
During the study period, 23% of cases were clinically occult and 77% were clinically recognized. From 2000 to 2012, however, the number of clinically occult cases represented more than half of the cases. The mechanism of detection from 2000 to 2012 was most commonly investigations of patients with symptoms or palpable nodules not clearly associated with thyroid cancer but which triggered diagnostic neck imaging (27%), followed by incidental discovery during neck imaging (19%) and review of specimens from thyroid surgery for a benign condition (14%).
“We are facing an epidemic of diagnosis in thyroid cancer,” Brito said. “Now that we know where all these new cases are coming from, we can design strategies to identify patients with thyroid cancer who can benefit from our treatment without condemning other patients to unnecessary tests, treatment, suffering and costs.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
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