Thyroid Cancer Overdiagnosed

 In this blog article, I will first look at the causal relationship between overdiagnosis and thyroid cancer (Section A). Thereafter, a few recommendation and useful information if one is under treatment (Section B)

Section A

The Evidence

With more than 14 million people living with cancer in the U.S. today and over 1.6 million new cancer cases diagnosed yearly. Yet the diagnosis rate of thyroid cancer has increased by 5 percent over the past decade for both men and women nationwide.

But Why IS Thyroid Cancer on the Rise?

Gary Bloom, executive director of ThyCa: Thyroid Cancer Survivors’ Association, Inc., tells us: “Medical professionals largely attribute the increase in thyroid cancer diagnoses to better imaging techniques, which has led to the discovery of many more micropapillary thyroid cancers — very small tumors that are usually less than 1 centimeter in size. However, some of the increase seems to have been in larger tumors, which is unrelated to better imaging.”

So is it overdiagnosis rather than an actual epidemic? According to a report published in JAMA, thyroid cancer has long been a common find during autopsies, despite never having caused symptoms during a patient’s life, indicating that nodules are extraordinarily common.

Theoretically, you can live with thyroid cancer without it negatively impacting you. So if you pair that with an increase in physical examinations of the neck and diagnostic imaging, you end up with more people diagnosed with thyroid cancer, which would indicate a rise in the disease.

“The discussion of overdiagnosis typically comes up with regards to a very small papillary (the most common) thyroid cancer,” Bloom explains. “The best course of action may be to watch and wait, rather than to actively treat.” He emphasizes that this form is not to be confused with rare variants of typical thyroid cancer and medullary and anaplastic thyroid cancers, which can be aggressive and difficult to treat.

Editorials
Overdiagnosis of thyroid cancer
BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i6312 (Published 30 November 2016)
Cite this as: BMJ 2016;355:i6312

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Louise Davies, associate professor of otolaryngology (head and neck surgery)1 2 3
Author affiliations
Correspondence to: L Davies, VA Outcomes Group, 111B, 215 North Main Street, White River Junction, VT 05009, USA Louise.Davies@Dartmouth.edu
Non-lethal cancers picked up by screening are probably responsible
Thyroid cancer incidence has increased dramatically in many countries in the developed world over the past three decades.1 Papillary thyroid cancer, which has been responsible for virtually the entire increase, is rarely lethal. The 20 year survival rate is greater than 90%, and approaches 100% for the smallest cancers.2 The increasing incidence is most likely due to overdiagnosis—the detection of subclinical cancers never destined to cause harm.3 4 This conclusion has been reached because the incidence has been primarily due to the detection of small papillary cancers, mortality due to thyroid cancer has not changed significantly, and small foci of papillary thyroid cancer are commonly found at autopsy in people who died of other causes. Overdiagnosis is a problem because it exposes people to the potential side effects of treatment, but without an equal expectation of benefit, because the cancer is unlikely to advance.
In a linked article in The BMJ,5 Park and colleagues extend our understanding of the issue in South Korea, which has seen a 15-fold increase in incidence over the past 10 years,6 …

http://www.bmj.com/content/355/bmj.i6312

PLoS One. 2017; 12(6): e0179387.
Published online 2017 Jun 14. doi:  10.1371/journal.pone.0179387
PMCID: PMC5470703
Overdiagnosis and overtreatment of thyroid cancer: A population-based temporal trend study
Sabrina Jegerlehner,1,* Jean-Luc Bulliard,2 Drahomir Aujesky,1 Nicolas Rodondi,1,3 Simon Germann,2,4 Isabelle Konzelmann,4 Arnaud Chiolero,2,4,5 and NICER Working Group¶
Karen M. Tordjman, Editor
Author information ► Article notes ► Copyright and License information ►

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Abstract
article-meta
Background
The increase in incidence of thyroid cancer during the last decades without concomitant rise in mortality may reflect the growing detection of indolent forms of thyroid cancer, and may have fueled unnecessary thyroidectomies. Our aim was therefore, to compare recent secular trends in surgical intervention rate for thyroid cancer with the incidence and mortality of thyroid cancer to assess overdiagnosis and resulting overtreatment.
Methods
We conducted a population-based temporal trend study in Switzerland from 1998 to 2012. All cases of invasive thyroid cancer, deaths from thyroid cancer, and cancer-related thyroidectomies were analyzed. We calculated changes in age-standardized thyroid cancer incidence rates, stratified by histologic subtype and tumor stage, thyroid cancer-specific mortality, and thyroidectomy rates.
Results
Between 1998 and 2012, the age-standardized annual incidence of thyroid cancer increased from 5.9 to 11.7 cases/100,000 among women (annual mean absolute increase: +0.43/100,000/year) and from 2.7 to 3.9 cases/100,000 among men (+0.11/100,000/year). The increase was limited to the papillary subtype, the most indolent form of thyroid cancer. The incidence of early stages increased sharply, the incidence of advanced stages increased marginally, and the mortality from thyroid cancer decreased slightly. There was a three- to four-fold increase in the age-standardized annual thyroidectomy rate in both sexes.
Conclusions
We observed a large increase in the incidence of thyroid cancer, limited to papillary and early stage tumors, with a three- to four-fold parallel increase in thyroidectomy. The mortality slightly decreased. These findings suggest that a substantial and growing part of the detected thyroid cancers are overdiagnosed and overtreated.
Impact
Targeted screening and diagnostic strategies are warranted to avoid overdetection and unnecessary treatment of thyroid cancers.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5470703/

Over the past couple of decades, there has been a significant increase in the incidence of thyroid cancer throughout the world.  This phenomenon is mainly seen in “high income” countries of North America, Europe, and Asia.  In the United States alone, the annual incidence has tripled between 1975 and 2009.  The upsurge involves papillary thyroid carcinoma (PTC), which comprises 90% of all thyroid cancers.  It is also the least aggressive, as evidenced by no increase in death rate from its surge.
Why is this happening? A study published in the New England Journal of Medicine ( NEJM, August 2016) sought to find out the reason for the thyroid cancer “epidemic.”  The researchers looked at cancer registry data from multiple countries and compared the change over time. The countries with the highest prevalence of thyroid cancer had two common denominators: improved access to diagnostic tests (ultrasounds, CT scans, and MRIs) and routine cancer surveillance.  Since there has not been any emergence of new risk factors for thyroid cancer, “more testing” seems to be the cause for the increase.
The researchers concluded that the rise in PTC was attributed to overdiagnosis rather than increase in occurrence of thyroid cancer. Since ultrasounds became available in the 1970s, small thyroid growths are being increasingly discovered through imaging, often unintentionally.  According to the researchers, 70-80% of thyroid cancers in the United States result from overdiagnosis of small, benign tumors. Between 1988-2007, there have been an estimated 228,000 such cases in the United States.
Why should we be concerned?  The problem with overdiagnosis is overtreatment.  The incidental discovery of small thyroid growths, that would have otherwise remained silent, creates a management challenge for physicians. The name “PTC” further increases anxiety for patients, likely resulting in surgical removal.  The researchers reported that a large number of the people in the study had surgical treatment, suggesting that many people are getting aggressive management for benign lesions that could have been managed conservatively.
Thyroidectomy (total or partial removal of the thyroid gland) has to be done by an experienced surgeon; and even then, it comes with a risk of injury to adjacent organs like parathyroid glands and vocal cords (voice box).  Such treatment may also involve lymph node removal and radiation therapy, offering additional risks. A study in Japan showed that, in small papillary thyroid cancers, the outcome was the same whether managed by surgery or careful surveillance.  In 1,235 patients, only 3.5% of the tumors progressed; and after follow up for 75 months, there were no deaths from these thyroid tumors.  Another problem with the PTC epidemic is the rising cost of care; in the United States alone, it was estimated to be $1.6 billion in 2013.
What is the solution? The medical community is taking steps to mitigate the issue. In 2015, the American Thyroid Society (ATS) revised its guidelines on the management of small thyroid nodules (

With more than 14 million people living with cancer in the U.S. today and over 1.6 million new cancer cases diagnosed yearly, it’s safe to say that you or someone you know has had a brush with cancer. Though cancer death rates have been in steady decline in the U.S., there is one form that is on a startling rise: thyroid cancer.

You read that right. Cancer-related deaths have been trending downward for both men and women over the past decade, meaning that more people are able to recover from the disease than before. Yet the diagnosis rate of thyroid cancer has increased by 5 percent over the past decade for both men and women nationwide.

What Exactly Is Thyroid Cancer?

The thyroid, a butterfly-shaped gland located in the front part of the neck, is responsible for producing thyroid hormones from iodine in the blood. These hormones affect your metabolism rate, which means they influence how fast or slow your brain, heart, muscles and liver work. So, yeah: They’re kind of important.

According to the American Cancer Association, thyroid cancer occurs when the cells in the thyroid gland begin to grow out of control. When normal thyroid cells grow old or get damaged, they die and new cells take their place.

The National Cancer Institute explains that when this process goes wrong, new cells form when the body does not need them and old or damaged cells do not die as they should. That leads to a buildup of extra cells that form a mass of tissue called a nodule — aka a growth or tumor.

While most thyroid nodules aren’t cancerous, if the nodes are malignant it indicates cancer. There are two main types of cells in the thyroid that account for 80 to 90 percent of thyroid cancers: follicular cells (that are in charge of thyroid hormone production) and C cells (that control how calcium is used in the body).

These differences are important because they will depend on what type of cancer is diagnosed and what type of treatment is needed. Thankfully, if detected early, most of these types of thyroid cancer can be treated successfully.

But Why IS Thyroid Cancer on the Rise?

Gary Bloom, executive director of ThyCa: Thyroid Cancer Survivors’ Association, Inc., tells us: “Medical professionals largely attribute the increase in thyroid cancer diagnoses to better imaging techniques, which has led to the discovery of many more micropapillary thyroid cancers — very small tumors that are usually less than 1 centimeter in size. However, some of the increase seems to have been in larger tumors, which is unrelated to better imaging.”

So is it overdiagnosis rather than an actual epidemic? According to a report published in JAMA, thyroid cancer has long been a common find during autopsies, despite never having caused symptoms during a patient’s life, indicating that nodules are extraordinarily common.

Theoretically, you can live with thyroid cancer without it negatively impacting you. So if you pair that with an increase in physical examinations of the neck and diagnostic imaging, you end up with more people diagnosed with thyroid cancer, which would indicate a rise in the disease.

“The discussion of overdiagnosis typically comes up with regards to a very small papillary (the most common) thyroid cancer,” Bloom explains. “The best course of action may be to watch and wait, rather than to actively treat.” He emphasizes that this form is not to be confused with rare variants of typical thyroid cancer and medullary and anaplastic thyroid cancers, which can be aggressive and difficult to treat.

Overall, there is not enough evidence to definitively explain why thyroid cancer is on the rise in America — whether it is due to overdiagnosis or something else.

Can You Protect Yourself Against Thyroid Cancer?

Bloom says that the best thing to do is avoid radiation at all costs. “It is important to limit exposure to head and neck radiation. For most people, the only exposure to radiation will be dental X-rays.” While this exposure is generally very limited, request a neck shield in addition to the chest shield that is usually provided.

Regular screenings can also catch thyroid cancer in earlier stages. “Anyone can get a neck check when they go for routine health checkups, whether from their internist/general practitioner or dentist (usually performs a cursory head and neck checkup). And for women their gynecologist often performs a neck checkup,” Bloom explains. You can always request one from your general practitioner. It takes less than a minute to perform and needs no special equipment.

There’s also a simple swallow test that you can perform with a partner at home if you want to stay on top of things. “The easiest way to do the self-check is at the dinner table!” Bloom tells us. “Sit across from someone, take a small amount of water into your mouth, tilt your head back so your neck is fully exposed, and have your dinner companion tell you when to swallow. The companion should stare at the outline of your neck looking for small bumps. Once completed, switch roles.”

How to Help Spread Awareness

“There is a great need to spread awareness about thyroid cancer, including that it occurs in all age groups, from children to seniors,” Bloom says. “We also need greater awareness about what to do after the diagnosis. It is especially important to be sure what type of thyroid cancer has been diagnosed, whether treatment is needed and, if so, what treatment.”

Bloom also explained that, similar to other cancers, it is increasingly important to support research and funding in order to find a cure as well as to learn to better manage and prevent this cancer.

If you would like to learn more, visit ThyCa: Thyroid Cancer Survivors’ Association, Inc., a nonprofit organization that is dedicated to spreading awareness about this disease, providing support and education and funding research.

Christian Joubert (ACRI director)

Evidence that Nigella Sativa (black seed oil) is clinically superior to many cancer drugs.

Disclaimer: Nothing in this educational blog should be construed as medical advise
2016 (c). Advanced Cancer Research Institute and agents. All Rights Reserved

Trained in Conventional, Traditional Chinese, Naturopathic and Wine medicine, Chris Joubert teaches how to extend a healthy Lifespan to 120 years and beyond. Concomitantly, he also teaches patients and health practitioners how to both prevent and reverse holistically most chronic diseases, including but not limited to neurological disorders like Alzheimer’s disease and depression, autoimmune diseases like Lupus, IBD & Diabetes, Cardiovascular, Respiratory & Joint illnesses, cancer and more. Having had over twenty years of experience with Holistic Oncology, Chris can share some of the best cancer control and reversal protocols that are safe, efficient and cost-friendly. Trained in Law, Professor Joubert also teaches health professionals to better protect their holistic practice when they must deviate from outdated “standards of care”. Joubert is presently working on a Documentary and book that redefines Medicine in light of new discoveries, ancient wisdoms, innovative research, holistic science and Joie de vivre (happiness) happenings. See links on “Contact” and “About” for details.

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