Excessive Diagnosis of Small Thyroid Cancers May Bring More Harm and Than Good

Juan P. Brito Campana, MBBS Division of Diabetes, Endocrinology, Metabolism, and Nutrition, Department of Medicine Mayo Clinic , Rochester, MinnesotaMedicalResearch.com Interview with:
Juan P. Brito Campana, MBBS
Division of Diabetes, Endocrinology, Metabolism, and Nutrition, Department of Medicine
Mayo Clinic , Rochester, Minnesota

Medical Research: What is the background for this study?

Dr. Brito: The occurrence of thyroid cancer is increasing faster than any other cancer in the United States. If this trend continues, thyroid cancer will become the third most frequent cancer in women in the next five years. Despite this increase, death related to thyroid cancer has not increased.  The reason is that the majority of the new cases of thyroid cancer are small papillary thyroid cancers. These cancers are the most benign variant of thyroid cancer and most patients diagnosed with this type of cancer never experience any symptoms or other negative effects. To better understand how these new cases of thyroid cancer are diagnosed we studied every case of thyroid cancer diagnosed in Olmsted, County, MN from 1935-2012.

Medical Research: What are the main findings?

Dr. Brito: We found that almost half the new cases of thyroid cancer were found among people who did not have any symptoms related to thyroid cancer. The most frequent reasons for identifying these patients presenting were review of thyroid tissue removed for benign conditions; incidental discovery during an imaging test ; and investigations of patients with symptoms or palpable nodules that were clearly not associated with thyroid cancer, but triggered the use of imaging tests of the neck.

Medical Research: What should clinicians and patients take away from your report?

Dr. Brito: Contrary to what we expected, many of these cases are not only found incidentally but clinicians are actively looking for them in patients without any evidence or symptoms attributed to thyroid cancer. Finding small papillary nodules does not bring a significant benefit to society or to the patients. In fact, the excessive diagnosis of small papillary thyroid cancer could lead to psychological and financial harm.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. BritoThese findings should highlight the need to understand the harms of overdiagnosis and overtreatment for patients with small thyroid cancers; and to develop strategies to curtail this phenomenon.

Citation:

Thyroid. 2015 Sep;25(9):999-1007. doi: 10.1089/thy.2014.0594. Epub 2015 Jul 30.

The Impact of Subclinical Disease and Mechanism of Detection on the Rise in Thyroid Cancer Incidence: A Population-Based Study in Olmsted County, Minnesota During 1935 Through 2012.

Brito JP1,2, Al Nofal A3, Montori VM1,2, Hay ID1, Morris JC1.

 

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Juan P. Brito Campana, MBBS (2015). Excessive Diagnosis of Small Thyroid Cancers May Bring More Harm and Than Good 

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