More and more Americans become ill with thyroid cancer than ever before - over the past 25 years of its incidence has tripled. This year alone, more than 50 000 people in the US will receive a diagnosis of thyroid cancer.
In an article in the journal New England Medicine, Doctor. Gilber Welch (Institute of Policy and Clinical Practice, Dartmouth) and Gerard Doherty (Surgery Department, Brigham and Women's Hospital) argue that this is a dramatic increase in the number of people diagnosed with thyroid cancer - largely reflects the detection of small papillary cancers of the thyroid gland - indicates widespread over-diagnosis. Efforts should be made to reduce over-diagnosis, such as abstinence from small biopsy of thyroid nodules, as suggested by the American Thyroid Association. But Welch and Doherty also actively support measures aimed at reducing the excessive processing. These include active surveillance for individual patients with small cancers of the thyroid gland.
In cases where patients prefer to remove the cancer, Welch and Doherty reported that the thyroid lobectomy (removal of approximately half of the thyroid gland), the smaller of the two available surgical options, as opposed to total thyroidectomy. Less extensive lobectomy carries a lower risk of damage to the nerves, avoiding the risk of hypoparathyroidism and in many cases allows patients to refuse to replace the thyroid hormone replacement.
The risk of death from thyroid cancer is very low, about 2%, and this risk does not depend on the choice of procedure - total thyroidectomy or lobectomy. Given this fact, one would expect that lobectomy is a common surgical procedure for these two. Surprisingly, as indicated by Welch and Doherty, the converse is true: the speed increases total thyroidectomy, with about 80% of patients who undergo total thyroidectomy.
Speaking about the reasons for this apparent contradiction - lack of knowledge about the new practice guidelines, difficulties associated with "deintensifikatsiey" care - Welch and Doherty, suggest that practitioners of primary health care can help by educating patients of cancer heterogeneity: not all types of cancer or a diagnosis cancer - the same - some cancers require aggressive treatment, some of the less aggressive treatment, while others are best left alone.
"The average age of diagnosis of thyroid cancer is 50, compared with the average breast cancer in '62," - says Welch. "So potentially someone could live up to half of their lives with the consequences - both physical and psychological - because of these treatments. This is something that we need to very seriously. "