An explosion in the use of ultrasound, MRI, and CT scans is driving what Mayo Clinic researchers are calling an "epidemic" in the diagnosis and treatment of low-risk thyroid cancers that are not likely to ever cause symptoms or death.
In a new report published online in the British Medical Journal, medical investigators with the Mayo Clinic Center for the Science of Health Care Delivery argue that an increasing gap between the rate of thyroid cancer and deaths from the disease suggests that low-risk forms of the disease are being overdiagnosed and overtreated.
"High tech imaging technologies such as ultrasound, CT, and MRI can detect very small thyroid nodules many of which are slow growing papillary thyroid cancers," said lead researcher Juan Pablo Brito, a health care delivery specialist at Mayo Clinic. "This is exposing patients to unnecessary and harmful treatments that are inconsistent with their prognosis."
Brito noted the surgical removal of all or part of the thyroid gland is costly procedure and can cause complications such as low calcium levels and nerve injury. Surgical removal procedures in the United States have tripled in the past 30 years — from 3.6 per 100,000 people in 1973 to 11.6 per 100,000 people in 2009, Brito said.
"Uncertainty about the benefits and harms of immediate treatment for low-risk papillary thyroid cancer should spur clinicians to engage patients in shared decision-making to ensure treatment is consistent with the research evidence and patient goals," he added.
Brito recommended using a new term that connotes a favorable prognosis for low-risk thyroid cancers, such as microPapillary Lesions of Indolent Course (microPLIC). A new term would make it easier for clinicians to offer patients the choice of active surveillance — watchful waiting, which not occurs for patients with low-risk prostate cancer — instead of immediate and often intensive treatment.
He also called for additional research to identify the appropriate care for these patients.
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