Living with cancer blog

The problem with overtreating thyroid cancers

By Sheryl M. Ness, R.N. November 2, 2013

Thyroid cancer is the most common cancer of the endocrine (glandular) system. Worldwide, the rate of thyroid cancer has increased over the past 30 years and in the United States it's tripled. But the rate by which people die from thyroid cancer hasn't changed.

Thyroid nodules are common (one in three people have a thyroid nodule). When a nodule is found, the best way to know if it's cancerous is to perform an ultrasound and needle biopsy. On average, 10 percent of thyroid nodules are found to harbor malignant (cancerous) cells on biopsy.

Thyroid cancer is divided into four different types:

  • Papillary — most common, excellent prognosis
  • Follicular
  • Medullary
  • Anaplastic — least common, worse prognosis

A patient who is considered to have a low-risk thyroid cancer has:

  • A nodule that is papillary type and measures less than 15 mm (slightly larger than the width of a staple) in size
  • No family history of thyroid cancer
  • No personal history of radiation exposure
  • No evidence of tumor spread outside of the thyroid (as measured by ultrasound)

Doctors have become concerned that we're overtreating some people who have low-risk thyroid cancers. That is, are we doing more harm than good in some cases?

This week, we discuss this topic with Dr. Juan P. Brito, a Mayo Clinic specialist in endocrinology who's studying this issue. I asked him a few questions.

Q: Why are we seeing an increase in thyroid cancer?

A: With the increase in screening and imaging tests available, many times small papillary thyroid cancers are found that would never have been discovered prior to this technology.

Q: What is the harm of treating low-risk thyroid cancers?

A: If a patient has surgery to treat the cancer, this puts the patient at risk of complications such as vocal cord injury (1-2 percent) and lifelong calcium replacement (2-4 percent).

In addition to the surgical risks, all patients undergoing surgery will need to be on thyroid hormone replacement therapy for the rest of their lives.

Treatment may also include the use of radioactive iodine which has its own adverse effects. Besides the risk of short and long term adverse effects from treatment, many patients will experience financial and emotional distress as well.

Q: What can be done to treat low-risk thyroid cancers more appropriately?

A: Cancer causes fear, anxiety and distress in patients — the normal reaction is to want to treat the cancer — even if it is small in size and has a low risk for progression. It may be time to re-think how these low-risk tumors are labeled and perceived both by doctors and patients.

Instead of labeling these low-risk tumors as cancerous, it might be time to change what they're called. We're suggesting that low-risk tumors be renamed to reflect their favorable prognosis. Instead of cancer, the new label suggested is papillary lesions of indolent course (PLICs).

We recommend that patients with PLICs be offered the option of active surveillance to detect changes and/or progression. This may include annual physical exam, ultrasound imaging and blood tests designed to look for any changes in the PLIC.

Have you been diagnosed with a low-risk papillary thyroid cancer? Share your experiences with us.


Sheryl M. Ness, R.N.

Nov. 02, 2013