The rate of thyroid cancer is increasing in the U.S. but there is controversy over what to do if you are diagnosed with it, a top expert says.
“There may be a true increase in thyroid cancer, but the concern is what to do about it if you develop it. There are important options that people need to know,” Dr. Allen Ho tells Newsmax Health.
A recent study finds that thyroid cancer cases in the U.S. more than tripled over the past four decades, and are continuing to rise more than 3 percent a year.
That study, published in the Journal of the American Medical Association last month, also found that the death rate for a particularly aggressive form of the disease – advanced papillary thyroid cancer – is increasing by one percent annually.
But the fact remains that thyroid cancer is a particularly slow-growing form of cancer, and too many people may be undergoing surgery because of it, says Ho, director of the Head and Neck Program at Cedars-Sinai’s Samuel Oschin Comprehensive Cancer Institute in Los Angeles.
“We expect more than 92 percent of patients will never see their cancers grow large enough to recommend surgery, and, for the 8 percent that do grow and need surgery, we expect their prognosis to be the same as those who had surgery from the very beginning," he says.
The thyroid is a butterfly-shaped organ at the base of the throat.
Nearly 57,000 new cases of thyroid cancer will be diagnosed this year. This includes 42,470 in women and 14,400 in men, the National Cancer Institute says.
Thyroid cancer is highly curable but it still causes about 2,000 deaths annually, statistics say.
Although it isn’t known what causes thyroid cancer, there are risk factors for the disease, the American Society of Clinical Oncology (ASCO) says.
Women and Asians are more likely to develop thyroid cancer, which is often diagnosed at a younger age than are other forms of the disease.
Other factors include the following: a family history of goiters or pre-cancerous colon polyps, certain genetic conditions, and radiation exposure for head and neck cancers, such as Hodgkin’s lymphoma or lymphomas, says ASCO.
Some studies find that breast cancer patients may be at increased risk, especially within 5 years of diagnosis, ASCO notes.
One of the reasons Ho and other experts believe that thyroid cancer may be overtreated is because most cases are picked up as "incidental" findings when an ultrasound scan is done for another reasons.
Chemotherapy and radiation are ineffective against thyroid cancer, so when it is found, the treatment is too often the removal of the entire thyroid gland, he says.
Last summer, a French research team published a study pointing out that a large fraction of thyroid cases represent overdiagnoses and, based on that, at least a half-million patients, most of them women, may have received unnecessary surgery and other cancer treatments.
Their warning comes from an analysis of cancer registry data from 12 countries, which was published that August in the New England Journal of Medicine.
“In the past, the recommended treatment was the total removal of the thyroid gland, followed by the taking of a radioactive iodine pill, which was soaked up by the thyroid cancer tissue, which then destroyed it," says Ho.
As a result, patients had to take synthetic thyroid hormone for the rest of their lives, Ho notes.
“Nowadays, radioactive iodine is only given for people whose cancer is high or intermediate-risk. The others don’t need it," he adds.
There are other options to thyroid gland removal, but patients need to be made aware of them, says Ho.
In many cases, only half of the thyroid gland needs removal. This means shorter recovery time, less risk to the vocal cords, and it eliminates the need for synthetic thyroid because the remaining half of the gland still pumps out the hormone, he says.
“We now take a more tailored approach, depending on the size of the tumor and the anxiety of the patient,” says Ho.
There is also another option, which is “watchful waiting," which means no treatment, but regular tests are performed to make sure the cancer hasn't grown, he adds.
Although Ho believes that this is a good approach for many people, it’s not known if there some tumors that appear to be low-risk but later become dangerous, he says.
To learn more, he is currently in the process of recruiting 200 thyroid cancer patients for a study that will take place over the next 5 years.
“This is still a controversial topic," he says. "We don’t know if this is the right approach or if it is right only for a subset of patients. There are a lot of patient advocates and physicians for or against it."
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