Research notes on topic of thyroid cancer
2017 Challenges posed by Birds, Rabbits, and Turtles by Gilbert Welch MD
Indiana University Cancer Center Grand Rounds on Overdiagnosis & Cancer Screening
50 minute video discussion of cancer screening which includes information on thyroid cancer screening
2016 Less Medicine, More Health by Gilbert Welch MD (affiliate link)
Pathologists have known for years that at least 1/3 of adults harbor small papillary thyroid cancers
Thyroid cancer diagnosis has increased threefold, but death rate has remained stable.
This sounds more like a epidemic of diagnosis than a real disease.
Overdiagnosis is a huge problem with thyroid cancer
Most of us could be found to have nodules in our neck if doctors looked hard enough
Many conditions that we think of as life-and-death issues turn out not to be.
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This is part of the article:
A large fraction of thyroid cancer cases represent overdiagnoses, and at least half a million patients, most of them women, may have received unnecessary surgery and other cancer treatments, say researchers from the International Agency for Research on Cancer (IARC), in Lyons, France.
Their warning about an epidemic of thyroid cancer overdiagnosis comes from an analysis of cancer registry data from 12 countries published August 17 in the New England Journal of Medicine .
Salvatore Vaccarella, PhD, and colleagues at the IARC estimate that more than 470,000 women and 90,000 men may have ben overdiagnosed with thyroid cancer in 12 “high-income” countries (Australia, Denmark, England, Finland, France, Italy, Japan, Norway, Republic of Korea, Scotland, Sweden, and the United States) from 1987 to 2007.
Most of these thyroid cancers were small, low-risk papillary carcinomas, they note. The “vast majority” of these patients underwent total thyroidectomy, and a “high proportion” also received neck lymph-node dissection and radiotherapy, but these interventions do not have “proven benefits in terms of improved survival,” the researchers point out.
“We don’t know whether this trend has continued, since post-2007 data were not available,” the researchers comment. “However, if we take the most recent available period, 2003 – 2007, as typical of current practice, we estimate that overdiagnosis in women accounts for 90% of thyroid-cancer cases in South Korea; 70 to 80% in the United States, Italy, France, and Australia; and 50% in Japan, the Nordic countries, and England and Scotland.”
The overdiagnosis is blamed on increasing medical surveillance and the introduction of new diagnostic techniques, such as neck ultrasonography (since the 1980s) and, more recently, CT scanning and MRI. This new technology has led to the detection of a large number of indolent, nonlethal diseases that exist in abundance in the thyroid gland of healthy people of any age, the researchers comment, adding that most of these tumors are very unlikely to cause symptoms or death.
“Countries such as the USA, Italy, and France have been most severely affected by overdiagnosis of thyroid cancer since the 1980s, after the introduction of ultrasonography, but the most recent and striking example is the Republic of Korea,” Dr Vaccarella commented in a statement. “A few years after ultrasonography of the thyroid gland started being widely offered in the framework of a population-based multicancer screening, thyroid cancer has become the most commonly diagnosed cancer in women in the Republic of Korea, with approximately 90% of cases in 2003 – 2007 estimated to be due to overdiagnosis.”
Iodine and Thyroid Health