Overdiagnosing Thyroid Cancer: What’s in a name?

When is a cancer not a cancer? When it can be described as a “subclinical disease,” according to a study in JAMA Otolaryngology — Head and Neck Surgery (http://tinyurl.com/thyroid-study). That’s just one of the solutions researchers offer to what they call an epidemic in thyroid cancer diagnosis. They suggest “relabeling incidentally identified small thyroid neoplasms, reclassifying them using a term other than cancer.”

Incidence of the disease tripled since the 1970s, while mortality rates have remained relatively stable. Most of the diagnosis has been for papillary thyroid cancer, a non-aggressive form that hardly ever threatens life, according to the study. “Unfortunately, our findings on current treatment patterns suggest that most thyroid cancers are still being treated as though they are destined to cause real problems for the people who have them.”

Most of the increase in diagnosis has been in women. “This is particularly notable because thyroid cancer prevalence at autopsy is actually greater in men than it is in women,” the study says. “This suggests that the problem of thyroid cancer overdiagnosis in women has probably been present for decades.”

Eighty-five percent of people diagnosed with thyroid cancer have total thyroidectomy, and not only are they at risk for postoperative complications, but they will need thyroid hormone therapy and monitoring for the rest of their lives. Providers “need to be asking themselves whether they are looking too hard for thyroid cancer. Patients — and in the case of thyroid cancer, particularly women — need protection not only from the harms of unnecessary treatment but also the harms of unnecessary diagnosis.”

Thyroid cancer incidence by histologic type, 1975–2009

Thyroid cancer incidence and mortality by sex, 1975–2009

Source: “Current Thyroid Cancer Trends in the United States,” JAMA Otolaryngology — Head and Neck Surgery, Feb. 20, 2014

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