Symptoms can include swelling or a lump in the neck. Advances in thyroid cancer research national cancer. Purpose differentiated thyroid cancer dtc incidence has been reported to have increased three to 15fold in the past few decades. A paper published late last year in the journal thyroid surveyed the incidence rate of thyroid cancer in other affluent countries across the globe and concluded that improved diagnostic. Acim australian cancer incidence and mortality books. The impact of overdiagnosis on thyroid cancer epidemic in italy,1998 2012. Thyroid cancermuch of the observed increase in incidence may be overdiagnosis28 breast cancer arguably the strongest evidence of overdiagnosis comes from studies of screening detected breast cancers, though estimates of its extent are wide ranging. Denver the epidemic in thyroid cancer recently reported by a number clinical journals has raised questions about overdiagnosis of thyroid cancer and overtreatment of papillary. According to dr gilbert welch in 2014 otolaryngology, there is an epidemic of overdiagnosis of thyroid cancer in young women.
Here we provide the first comprehensive analysis of the possible drivers of overdiagnosis and related overuse, mapped to potential solutions. In her book the patient paradoxwhy sexedup medicine is bad for your. The increasing incidence of thyroid cancer in the united states, 19732002. The overdiagnosis of cancer and unnecessary chemo and. Long term outcomes with active surveillance of low risk ductal carcinoma in situ and localised prostate cancer are also good. Thyroid cancers overdiagnosed in canada for in 75 percent.
Thyroid cancer article pdf available in journal of clinical pathology 3210. We address 1 essential thyroid cancer facts, 2 the evidence supporting overdiagnosis, 3 the role of radiology in overdiagnosis, 4 harms of overdiagnosis, and 5. The same trend applied to men, but to a lesser degree. Responses to overdiagnosis in thyroid cancer screening among. Although the clinician cannot know which microtumors might become problematic, active surveillance probably will not hurt the patients prognosis. How overdiagnosing can go terribly wrong literary hub. Thyroid cancer support dr toms thyroid cancer blog. Prior awareness of overdiagnosis in thyroid cancer screening was 27. Similar increases have been described in other countries 25. Thyroid cancer is cancer that develops from the tissues of the thyroid gland. Overdiagnosis is when an asymptomatic cancer is identified through medical technology, but the cancer is either noninvasive or so slowgrowing that it would never cause medical problems or be lifethreatening.
Medicine is frequently disparaged for treating patients only after they present with symptomsholmes certainly got mileage out of itbut, in many cases, this happens to be a prudent way to identify those who really need. In the united states and australia, overdiagnosis accounted for about 45 percent of thyroid cancer in men over that fouryear period. Over the last two decades, a major concern regarding thyroid cancer has been overdiagnosis that is, the detection of small, slowgrowing thyroid tumors that may never cause a medical problem. Louise davies discusses overdiagnosis and overtreatment of subclinical. The tree of overdiagnosis is rooted in an approach to medical care that seeks to identify. The impact of overdiagnosis on thyroid cancer epidemic in italy,19982012. Soaring diagnoses in south korea and elsewhere could be attributable to increased screening and could lead to unnecessary treatment.
This article describes thyroid cancer overdiagnosis for radiologists in the format of five questions. Notwithstanding, newly diagnosed thyroid cancer patients will. Dramatic increases have been seen over recent decades in the reported incidence of thyroid cancer, but owing to new modes of screening, hundreds of thousands of cases may be overdiagnoses. Reducing overdiagnosis in primary care is needed ncbi. It is unclear whether this represents overdiagnosis or a true increase in incidence. An epidemic of overdiagnosis of thyroid cancer in women. Although screening saves lives in some cases, in others it may turn people into patients unnecessarily and may lead to treatments that do no good and perhaps do harm. Causes of too much medicine include expanded disease definitions. Most commonly presents as an asymptomatic thyroid nodule detected by palpation or ultrasound in a woman in her 30s or 40s. Study points to overdiagnosis of thyroid cancer the new. Prognosis and survival for most carcinomas of the thyroid has long been known to be excellent. Being just diagnosed with thyroid cancer, i keep telling myself to be careful with what i read online and in books as every situation is different.
Since ultrasounds became available in the 1970s, small thyroid growths are being increasingly discovered through imaging, often unintentionally. Between 1992 and 2011, the korean thyroid cancer rate increased by a factor of 15, making it the worst in the world for the disease. Thyroid cancer incidence and overdiagnosis in korea thyroid cancer screening program in korea. A study by researchers at the university of calgary suggests theres an overdiagnosis. Treatment differs and must be tailored for uncommon types of thyroid cancer such as medullary, lymphoma, or anaplastic.
Shots health news the number of people diagnosed with thyroid cancer has tripled since 1975, but more lives havent been saved as. Overdiagnosis could be behind jump in thyroid cancer cases. Thyroid cancer often overdiagnosed, whos cancer arm says. Experience of us patients who selfidentify as having an.
For example, overdiagnosis of breast, prostate, thyroid, and lung cancer is driven largely by screening and early detection programmes, 29 so potential biases include lead time. A highly magnified photograph of cancer in the thyroid gland. Mapping the drivers of overdiagnosis to potential solutions. Overdiagnosis was well recognized in the second half of the 20th century from the advent of widespread screening for cancers. In anticipation of this years 3rd conference in washington, i reread welchs book. He was an internist at the veterans administration medical center in white river junction, vermont, as well as a professor of medicine at the dartmouth institute for health policy and clinical practice. What is overdiagnosis and why should we take it seriously in cancer. Our approach to the initial and updated pubmed searches of the literature is outlined in the data supplement see and yielded a total of 36 articles, to which we added a further five fig 1. Therefore, the current study aimed to estimate the prevalence of incidental dtc in published autopsy series and determine whether this prevalence has been increasing over time. 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 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. Overdiagnosis is the diagnosis of illnesses that would never have. The overdiagnosis of cancer breakaway consciousness. Cancer can also occur in the thyroid after spread from other locations, in which case it is not classified as thyroid cancer.
Tp is a medical doctor and phd candidate, undertaking her doctorate about overdiagnosis of prostate cancer at the centre for research in evidencebased practice crebp at bond universitys faculty of health sciences and medicine, australia. In thursdays issue of the new england journal of medicine, they estimated that more than 470,000 women and 90,000 men in those countries may have been overdiagnosed with thyroid cancer over 20. The 20 year survival rate is greater than 90%, and approaches 100% for the smallest cancers. Competing interests jb is a member of the board and scientific committee of the overdiagnosis conference with international partners as the bmj plus dartmouth. For men, the fear is not much lessened with overdiagnosis climbing to 45% in the u. The incidence of thyroid cancer in the united states has tripled in the past 30 years, from 3.
Researchers suggest there is an overdiagnosis epidemic. According to canadian cancer statistics 1, the incidence of thyroid cancer in women in canada has been increasing steadily at 7% per year since the mid2002. Susan loves breast book this book makes a compelling case against excessive medical screening and diagnostic testing in asymptomatic people. Increasing incidence of thyroid cancer in the united states, 19732002. Because most thyroid cancers are primarily treated by surgery, i. In an exclusive interview, thyroid cancer expert and surgeon dr. These tumors, also called nodules, are detected through. Overdiagnosis blamed for global increase in thyroid cancer. Revisiting overdiagnosis and fatality in thyroid cancer. Overdiagnosis is a growing issue, highlighted for example in the bmj and dr welchs thoughtprovoking book overdiagnosed.
Overdiagnosis of thyroid cancer8 is attributable to. In september 2018, welch resigned from dartmouth college after a 20month long research misconduct investigation at. Michael tuttle, md, describes the problem of overdiagnosis in thyroid cancer and the trend toward observing small thyroid nodules. Back in 2012, the national cancer institute convened an expert panel to evaluate the problem of cancers misclassification and subsequent overdiagnosis and overtreatment, determining that millions may have been wrongly diagnosed with cancer of the breast, prostate, thyroid, and lung, when in fact their conditions were likely harmless. The rise of thyroid cancer by overdiagnosis american. The study found that thyroid cancer incidence rates increased in canada by five and six times in men and women respectively between 1970 and 2012 with unchanged mortality rates. Thyroid cancer symptoms, diagnosis and treatment bmj. For women, the risk of thyroid cancer overdiagnosis ranges from 50% to as high as 7080% in the u. Gilbert welch is an american academic physician and cancer researcher. The korean government introduced the national cancer screening and health checkup programs in 1999 ahn et al. Overdiagnosis is the diagnosis of disease that will never cause symptoms or death during a. Thyroid cancer incidence has increased dramatically in many countries in the developed world over the past three decades.
Treatment is usually total thyroidectomy followed by radioactive iodine ablation and tsh suppression papillary. The incidence of differentiated thyroid cancers, especially the papillary subtype, has been increasing worldwide. The equally stimulating preventing overdiagnosis conferences were another. The challenge of overdiagnosis begins with its definition the bmj.
Rates of thyroid cancer diagnosis have tripled in the past 3 decades, but death rates from the disease have remained the same. Overdiagnosis is a side effect of screening for early forms of disease. The most important diagnostic test is fineneedle aspiration. H gilbert welchs bookoverdiagnosedwas one of my first introductions to the controversies of too much medicine. Thyroid cancer overdiagnosis raises questions about. Importance overdiagnosis of cancerthe identification of cancers that are unlikely to progressis a source of discomfort and challenge for patients, physicians, and health care systems. All authors contributed to revisions with important intellectual content and approved the final version of the manuscript. Researchers suggest there is an overdiagnosis epidemic in thyroid cancer open this photo in gallery. It is a disease in which cells grow abnormally and have the potential to spread to other parts of the body.
Alum jax cole thyroid cancer epidemic of overdiagnosis. Prevalence of differentiated thyroid cancer in autopsy. Mapping the drivers of overdiagnosis to potential solutions paper. The seer database from the united states showed a threefold increase in thyroid cancer incidence from 1975 to 2010, with a relatively stable thyroid cancerspecific mortality rate. Age standardised thyroid cancer incidence and mortality rates per 100 000 males females in australia. The causes of the increase have traditionally been assumed to be environmental exposure to atmospheric radiation and iodine insufficiency 6, but recent research. Getting at the roots rather than pruning the branches of. And the korean medical industry responded to the crisis with full force.
The rate of thyroid cancer rose at an alarming rate, with yearly increases. Perhaps the most serious story of overdiagnosis is thyroid cancer. In july 2016 the journal joined forces with the overdiagnosis standing group of the uks. Estimating the magnitude of cancer overdiagnosis in australia mja. Welcome evidence that more testing and treatment is not always better. We are some way off knowing how best to investigate for thyroid cancer, particularly now that its clear that harm can arise from overinvestigating. Study points to overdiagnosis of thyroid cancer the new york. Surveillance, epidemiology, and end results seer data suggest that the incidence of thyroid cancer in women is about three times higher than the incidence of thyroid cancer in men 21. In cancer screening, overdiagnosed cancers are those that did not. Overdiagnosis is the diagnosis of disease that will never cause symptoms or death during a patients ordinarily expected lifetime. Treatment is usually total thyroidectomy followed by radioactive iodine ablation and tsh suppression papillary or follicular. In thyroid cancer, as patients have begun to understand this concept, some individuals. The researchers concluded that the rise in ptc was attributed to overdiagnosis rather than increase in occurrence of thyroid cancer. This rise in thyroid cancer diagnosis has been linked to the increased use of.
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