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Some thyroid cancer treatments 'unnecessary', warn experts


Some patients with low-risk thyroid cancer are undergoing unnecessary treatment, experts have warned.

A dramatic rise in the number of thyroid cancer cases at a time when death rates remain stable is “most likely an effect of over-diagnosis”, they said.

The number of people diagnosed with thyroid cancer in England has doubled since the early 1990s, according to data from the National Cancer Intelligence Network (NCIN).

Between 1990 and 1994, around 900 people were diagnosed with thyroid cancer every year in England. But figures from 2006 to 2010 showed a jump to 1,950 cases a year.

Most of this increase is in a particular type of thyroid cancer called papillary cancer.

The rise has been linked to increased diagnosis of the disease due to techniques such as ultrasound and fine needle biopsies that can pick up much smaller cancers.

But experts writing in the British Medical Journal (BMJ) said picking up these papillary cancers “usually triggers intensive treatment”, even though they are unlikely to lead to an early death.

“This is exposing patients to treatments inconsistent with their prognosis,” said the team from the Mayo Clinic in Minnesota, US.

“Both the overdiagnosis and over-treatment of this form of cancer need to be fully recognised.”

Dr Claire Knight, health information manager at Cancer Research UK, said: “Like the US, England has seen a dramatic rise in the number of thyroid cancer cases diagnosed over previous decades.

“Much of this increase has been among papillary thyroid cancers, a type which has a very good prognosis.

“It’s not clear whether this increase is due to more people actually developing the disease, and if so why, or if it’s down to better imaging and diagnostics picking up cancers which may never have gone on to cause a person harm - this is called overdiagnosis.

“It’s important that researchers and doctors are aware that overdiagnosis of thyroid cancer is a real concern and that patients, particularly those with papillary thyroid cancer, are able to discuss treatment options with their doctor.

“More research will help us understand the biology of thyroid cancer, which cancers need treating, and which are so slow-growing that they will not cause a person any harm.”


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Readers' comments (3)

  • I totally agree. I was diagnosed with papillary thyroid cancer in 2005 and underwent two operations to remove my thyroid and then three doses of radioactive iodine. I kept asking what would happen if nothing was done about the cancer and no one seemed to give a clear answer. When the doctor suggested I have another does of radioactive iodine I declined and instead got referred to the Royal Marsden. At my first consultation at the Marsden they agreed we would watch and wait before having any more treatment, I have now been going there every three months for 6 years and I have not needed any more treatment. It just shows if I hadn't changed hospitals I would have gone through yet another high dose of radiation. It makes me wonder if I could have done without having any radiation at all!

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  • Catherine Parker | 29-Aug-2013 10:05 am

    this is very worrying and also particularly common where private insurance is concerned, where a lot of unnecessary interventions have been found to have taken place, or maybe where the evidence base is weak or unclear.

    It shows a need to question every intervention, at least I would and it is fortunate you have done as well.

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  • Cancer care is often cautious about claiming over treatment as there would be a huge issue if people die unecessarily, (Tamoxifen story today). The reason for this positive note, is that over diagnosis is an issue as there are far more investigations ordered which can then pick up incidental thyroid nodules. There are trials going on at the moment to look at whether radioactive iodine treatment is even necessary for some people (ION) and previously there has been a trial looking at the dose of radioactive iodine (HiLO trial). It is purely because this is very treatable and curable that after many years we can be so bold as to NOT treat. You must however, remember that some papillary cancers do need surgery as they are symptomatic and even metastasize so it is not about ALL thyroid cancer. There are also other thyroid cancers that convey a much less favourable outlook, such as anaplastic thyroid and some meduallary thyroid cancers so caution about this being a blanket statement.

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