New and improved technology has led to an increased rate of thyroid cancer diagnoses in the last few decades, but research has shown that surgery isn't always the best option.
AUG 17 2016, 8:20 PM ET
Study Finds Thyroid Cancer Diagnoses Rise, But Treatment May Not Be Best
by PARMINDER DEO, FELIX GUSSONE, MD and SAMUEL SARMIENTO, MD
In 2014, Megan Serrano anxiously waited in her doctor's office when she received the dreaded news that she had thyroid cancer.
She says it all started when she felt something weird in the back of her throat, but after visiting a clinic, receiving an ultrasound, and being handed her results Serrano decided not to have her cancer treated, for now.
"I feel like I did a good thing," the busy 44-year-old mother of two said. "I don't have to rely on medication, get surgery, or be away from my kids for a week because of radiation."
Thyroid cancer diagnoses have tripled in the last three decades, a new report published in the New England Journal of Medicine Wednesday says, and not all of those cancers may need immediate treatments that can be aggressive — like surgery, radiation therapy and the potential for lifelong medications.
The paper found new technology that is picking up smaller growths is contributing to overdiagnosis of thyroid cancers across the world, mainly involving small papillary carcinomas — a low-risk thyroid cancer which was Serrano's diagnosis.
The authors estimated that 70 to 80 percent of thyroid cancer patients were overdiagnosed in the U.S. alone. In South Korea the rate was as high as 90 percent, the report said.
"This perspective is interesting because it highlights the fact that it's a global problem," says Ahmedin Jemal, vice president of the Surveillance and Health Services Research Program at the American Cancer Society.
"While the majority of the increase might be due to over diagnosis, not all of it is," he said. "There are other factors: changes in diagnosis and risk factors like obesity."
After Serrano was diagnosed, she did her research and met with Dr. Brett Miles, Associate Professor of Otolaryngology Head and Neck Surgery at Mount Sinai Hospital in New York, for a second opinion.
"When I first got the diagnosis I really wanted to be sure that I wasn't looking only at the research that told me it was okay not to get surgery," Serrano said.
Serrano is now monitoring her cancer, and increasingly more patients are taking the watchful waiting approach. However, it's not for everyone. According to Miles, good candidates for observation are ones in a low risk category, have a small cancer, and show low-grade features on a biopsy.
He said Serrano's cancer was very small and that they made the decision for watchful waiting together. "I consider myself more of an educated risk adviser," Miles said. "I put together data and experience and present it to the patient. Patients are more involved in the decision making now. Even though it sounds surprising, many small thyroid cancers are not threatening and don't require immediate surgery or other treatment. In this case, "watchful waiting" is often the right choice. "You may be a good candidate for observation if you have a low-risk profile," Miles said.