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Daen Morrison
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Are doctors overtreating thyroid cancer
One of our stories this week was on thyroid cancer. A study published in the Canadian Medical Association Journal showed the incidence of thyroid cancer is rising more quickly than any other cancer in Canada.


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BriefingWire.com, 12/08/2018 - But to our surprise, the researchers suggest that the staggering 146% increase in the past 12 years is due almost solely to the fact small tumours less than 2 centimeters in diameter are being detected during tests for other problems. And these small tumours, they speculate, may be harmless.

“There is no epidemic of thyroid cancer,” Dr Stephen Hall of the Cancer Research Institute at Queen’s University in Kingston, Ont. told me in an interview.

“The epidemic is in the detection of smaller asymptomatic cancers,” he said.

U.S researchers came to the same conclusion in 2006 in a paper published in the Journal of the American Medical Association titled: “Increasing Incidence of Thyroid Cancer in the United States, 1973-2002”.

The authors concluded: ‘The increasing incidence of thyroid cancer in the United States is predominantly due to the increased detection of small papillary cancers. These trends... suggest that increasing incidencereflects increased detection of subclinical disease, not anincrease in the true occurrence of thyroid cancer.”

All of this could mean that many patients are being overtreated. They’re having their entire thyroid removed when perhaps they either need just part of the gland removed.  

Some, doctors suggest, may not need surgery at all - just watchful waiting, just as they do for some men with low-grade prostate cancer. They would receive regular monitoring to see if the small cancer B17 vitamins grows or remains dormant. 

In fact, the Kingston team from the CMAJ study is planning a new study to see if this treatment idea is a good option. It would be a huge shift in how thyroid cancer is treated.

I have had 3 friends who have undergone surgery to have their thyroids removed. It was a stressful, draining, frightening process. Whether the tumour was small or not, they wanted it gone.

With prostate cancer, the side effects of having their entire prostate removed can be significant - including incontinence and impotence.

With thyroid surgery, most patients recover fully, and with medications, return to an excellent quality of life.

Rita Banach, founder of Thry’vors, the Canadian Thyroid Cancer Survivor Support Group has concerns about the message coming from the new study.

 “Just because a lot of the tumours being found are small doesn’t mean they are harmless and don’t need treatment,” she said.

And she has another worry - by dismissing the rapid growth of thyroid cancer as the result of “over diagnosis” the study authors are detracting from the bigger question: why are so many thyroid tumours taking root in the first place? 

Theories abound on possible triggers, including environmental radiation, pollution and genetics.

Even doctors say that over-detection can’t explain why Ontario has four times the rate of thyroid cancers compared to Prince Edward Island… and double the rate in B.C.

Because thyroid cancer affects a smaller number of people compared to other cancers – the latest numbers suggest it affects 6.6 women per 100,000 and 2.2 per 100,000 men -- there isn’t much research into what triggers it.

Maybe we are picking up more cases because of better diagnostic tests.

Maybe some patients can afford to wait and see if the tumour is growing and surgery is even necessary.

But my question is: why are so many people developing it at all?

 
 
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