The argument for overdiagnosis and overtreatment of thyroid cancer may sound counter-intuitive. A person can live with cancer inside them and never suffer from that cancer. Further, according to the U.S. Preventive Services Task Force, just screening for thyroid cancer can cause side-effects. In this day and age of advertising about the importance of mammograms and PSA testing, it is difficult to read studies that question the benefits of screening for cancer.
In the case of thyroid cancer, Dr. Gilbert Welch says it best-“”If you look early, you just find a whole new category of patients that has the disease but is never going to suffer from it at all”
I began learning about the potential harms of looking for cancer “early” when my dad had a biopsy for possible prostate cancer. Not only did dad experience significant pain and bleeding during the days following his PCa biopsy but according to research, biopsies themselves can cause infections. My dad’s urologist told him that he did, in fact, have some cancer inside his prostate. But being an 80 year old man with several other health challenges (co-morbidities), my dad decided not to undergo any therapy. I hate to think of how dad’s last years would have been like had he undergone therapy for prostate cancer…
My dad died at 89 of heart failure…
I understand that testing for cancers may be a good thing. I understand, more the most, how cancers caught early can be cured. However I also understand that identifying pre-cancers can lead to over-diagnosis and over-treatment.
The reason for this post is to stress the need to learn about the pros and cons of screening for specific cancers. In the case of thyroid cancer, screening causes more harms than it helps.
“Most people diagnosed with cancer want to start treatment as soon as possible, for fear that delaying care will allow their tumor to grow out of control.
So Terry DeBonis’ approach to treating her thyroid cancer might seem surprising. Although she was diagnosed with cancer four years ago, she still hasn’t begun treatment.
Instead of removing her tumor immediately, the traditional approach, DeBonis and her doctor decided to wait and watch her cancer, monitoring it with ultrasounds every six months. DeBonis opted to consider surgery only if her tumor grew significantly bigger.
DeBonis, 55, said she had good reason to avoid surgery. She endured two painful surgeries on her collarbone related to a car accident just a year before her cancer diagnosis.
“There are risks and complications with every surgery,” says DeBonis, a nurse in Glen Rock, N.J. “I didn’t want to put myself through that…”
About one-third of patients with a slow-growing type of thyroid tumor, called papillary thyroid cancer, are eligible to delay treatment, says Dr. R. Michael Tuttle…
In Tuttle’s study, 291 patients whose tumors were considered low risk opted for a watch-and-wait approach. Doctors recommended that anyone whose tumors grew more than 3 millimeters — about the smallest change visible on an ultrasound — consider surgery…
And to the researchers’ surprise, 19 patients saw their tumors shrink by at least half, the study said. “I would not have guessed that would happen in a million years,” Tuttle says…
In the end, only 10 patients opted to have surgery, according to the study.
Older patients were the least likely to see their tumors grow, Tuttle says…”
“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 over treatment…
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.”
“An industry-backed foundation has been putting out that message, with Stewart as a celebrity spokesman, but it’s not based on sound science. No major medical organization recommends mass screening for thyroid cancer.
Now, the U.S. Preventive Services Task Force has added its forceful voice to the mix. The federal oversight group puts thyroid cancer screening in its don’t-do-it category, in recommendations published in the Journal of the American Medical Association on Tuesday.
“The harms outweigh the benefits,” task force member Dr. Seth Landefeld says. “We would recommend against screening for thyroid cancer in adults who have no symptoms.” Landefeld is chairman of the Department of Medicine at the University of Alabama, Birmingham…
“If you look early, you just find a whole new category of patients that has the disease but is never going to suffer from it at all,” says Dr. H. Gilbert Welch at the Dartmouth Institute for Health Policy and Clinical Practice. “But they will suffer from the treatment.”
Once growths are discovered, surgeons almost always remove the patient’s thyroid gland.
The surgery can have significant side-effects. Surgeons can sever the nerves that help control swallowing and speech, or remove the parathyroid gland, which regulates calcium. Patients go on a lifelong prescription of thyroid hormone.
“South Korea is the poster child for the problem of overdiagnosis” of thyroid cancer, Welch says. About 15 years ago, doctors there started a mass campaign to screen for thyroid cancer. That vastly increased the rate of thyroid cancer, to the point that it exceeded cases of breast cancer and other common malignancies.
Yet Welch notes that the mortality rate from this cancer didn’t change at all. “So all these extra cases were cases of thyroid cancer that weren’t destined to bother people,” he said. Instead, that rash of overdiagnosis sent people into needless surgery…