Epidemic or Thyroid Cancer Over-diagnosis?

The AMERICAN THYROID ASSOCIATION recognizes that the recent increase in incidence of thyroid cancer in the United States and other countries is, in large part, due to the over diagnosis of indolent papillary microcarcinomas that will never result in symptoms or death, and which only rarely will enlarge or spread beyond the thyroid gland. The issues surrounding this problem are twofold: First, medical imaging is identifying small nodules, well below the limits of clinical detection. Second, these small nodules are subjected to ultrasound-guided FNA, and about 5% reveal cancer cells. The usual next step is surgical removal, often followed by radioactive iodine and life-long thyroid hormone therapy. This approach is costly, creates risks from the treatments, and in most patients offers little or no benefit.

AMERICAN THYROID ASSOCIATION Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer (Thyroid, 2016) address this issue with three important recommendations/suggestions: (1) do not perform thyroid FNA on nodules < 1 cm unless there is evidence of extrathyroidal extension or of lymph node or distant metastases; (2) restrict surgery (currently the Standard of Care) to lobectomy and avoid radioactive iodine in those with low risk features; and (3) conduct further research (preferably in the setting of an IRB-approved clinical trial) to define the role of active surveillance instead of surgery for patients with low risk tumors (as is currently done for men with indolent prostate cancer).

While additional scientific and medical knowledge is required, the AMERICAN THYROID ASSOCIATION advises that, in the interim, these recommended clinical measures may reduce the recent increased incidence of thyroid cancer and prevent overtreatment of low risk cancer.

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