Looks like the thyroid is going the way of the spinal disc, with a diagnostic system prone to overdiagnosis, false positives and aggressive, unnecessary treatment. A recent study finds that thyroid cancer diagnoses have nearly tripled since 1975, and many, the study claims, are treated more aggressively than necessary. And although thyroid cancer remains rare overall, this study points to the we-do-because-we-can phenomenon potentially at play.
The study, published online Thursday in JAMA Otolaryngology, found that thyroid cancers jumped from 5 cases per 100,000 people to 14 per 100,000. Because the most common treatment is surgical removal, which is recommended and carried out in over 85% of thyroid cancer cases, the study calls into question the practice as many thyroid cancers (along with certain breast, lung and prostate cancers) have been shown in previous studies to be slow growing, and not deadly.
The thyroid is a hormone-releasing gland (endocrine) in the neck that helps regulate the body’s metabolism. Thyroid cancer treatment often includes surgery to remove the butterfly-shaped gland, followed by lifelong daily hormone pills.
However the study’s authors believe that the low risk of the majority of thyroid cancers really calls industry standards into question. Says Dr. Gilbert Welch, co-author of the thyroid study and a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, patients “can no longer assume” that labeling a disease as cancer means treatment is necessary. “It’s a challenging rethinking,” he added.
Yes precisely. With the arrival of newer, more accurate diagnostic testing, diagnoses go up almost by necessity. We saw it happen with the advent of advanced diagnostic imaging, or radiology. Along came MRIs and up and away went herniated disc diagnoses. Were there more herniated disks than ever before, needing more discectomies than ever before? If judging by the enormous rise in numbers of bulging discs discovered by MRI, then yes!…it would seem so to the indiscriminate eye. But as one of my teachers in chiropractic college would say so eloquently, “When all you have is a hammer, everything looks like a nail.”
I have always felt that one should be careful in how vigorously one chooses to ‘locate’ a problem, because I have always felt that one might just get what one is looking for…or worse. Not that people shouldn’t be prudent in trying to figure out why they might not be doing/feeling well. However, when the doc tells you that you are okay…well then gosh… I feel like far too many people become adamant about finding something. And this story certainly confirms to me that we (almost) always get what we are looking for. But in this case the thyroid cancer diagnoses are questionable…and the subsequent treatment (a thyroidectomy) is too.
“Our old strategy of looking as hard as possible to find cancer has some real side effects,” said Dr. Gilbert Welch
Hey I don’t deny that some people just feel better from getting medical procedures done—any procedure for some people, as I know one couple that prides themselves on their annual body parts removals…seriously…ok maybe ‘pride’ is subjective. Nonetheless they seem to feel comfortable (and happy) each time they get this or that procedure done. Great. To each his own.
But if you aren’t really into donating your body parts to science, then I would question everything. Find out if the “-ectomy” is truly necessary. And doctors it is okay to discuss it with the patient, and not simply assume that he would be as open to the idea of surgery if he were to understand that risk of death (without tumor or gland removal) is rather low.