Overdiagnosis of Juvenile Thyroid Cancer

Overdiagnosis is the detection of a disease that does not do any harm to the patient throughout the lifetime. Thyroid cancer in children is a rare disease; however, since 2011, many children in Fukushima, Japan, have been diagnosed with it, and the number has shown a steady increase to over 200 cases at present. Some experts have stated that this phenomenon is due to overdiagnosis caused by thyroid ultrasound (US)-based thyroid screening detecting self-limiting thyroid cancer, which will not lead to clinical symptoms in the future. Harm caused by overdiagnosis of thyroid cancer is more serious in the young, since it is difficult to perform active surveillance and children diagnosed with cancer are likely to suffer from stigma. Thus, overdiagnosis of thyroid cancer in the young is not only a health problem but also a problem of human rights. Conflicts of interest among people related to screening programs and some experts with incomplete knowledge on overdiagnosis help to spread misleading opinions together with fear of radiation exposure among residents, which has led to their erroneous understanding of the nature of US-based thyroid screening. Scientific and honest discussions among experts to enhance education of residents and consideration of medical ethics are crucial to prevent the expansion of overdiagnosis.

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Rising thyroid cancer incidence in Kerala: Is it real or over diagnosis?

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e17589 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e17589-e17589

Author(s):

Saadvik Raghuram ◽

Bharadwaj Ponnada ◽

Pavithran Keechilat

Keyword(s):

Thyroid Cancer ◽

Cancer Patients ◽

Clinical Symptoms ◽

P Value ◽

Newly Diagnosed ◽

Main Mode ◽

Screening Programs ◽

Cancer Registry Data ◽

Initial Surgery ◽

Mode Of Detection

e17589 Background: There has been an increase in the incidence of thyroid cancer in India and in high income countries. One of the reasons for this has been attributed to the large number of screening programs. Kerala state ranks second highest in the incidence of thyroid cancer in India. Screening provides the advantage of early detection of cancer and successful treatment but also tends to over diagnose. Methods: To study the trend of incidence of primary thyroid cancer among newly diagnosed cancer patients and its association with the mode of detection, we retrospectively reviewed hospital based cancer registry data of patients with thyroid cancer who were treated at AIMS (Amrita Institute of Medical Sciences), Kochi between 2004-2014. All patients who were newly diagnosed with primary thyroid cancer at our center or referred to us after initial surgery were included in this analysis. Patients with recurrent cancer/metastases were excluded. Results: We analyzed the records of 2,315 newly diagnosed thyroid cancer patients. Median age was 44.1yrs (range 13-90yrs). There were 619 males and 1696 females. Papillary type was the most common 85.8% followed by follicular type 7.4%. 1235 cases were operated at AIMS. 74 cases (3.2%) were diagnosed incidentally by Ultrasonography/PET scan/CT scan. All others (97% n = 2,245) presented with neck swelling. It was seen that the proportion of new cases of thyroid cancer among all new cancer cases was increasing serially from 4.6 % (n = 106, 95% 2004) to 7.4% (n = 195) to13.7% (n = 317, 2014). There was a significant increase in the number of cases of T1a and T1b at the time of diagnosis during the study period (n = 1235, p value < 0.001 and p value for trend < 0.001 respectively) which indicates that there was early diagnosis. 97% of the cases presented with thyroid related symptoms indicating that clinical presentation has still been the main mode of detection in our series. Conclusions: Our data shows that there may be a true increase in the number of cases of thyroid cancer as majority presented with clinical symptoms, except few detected incidentally. As it is a single institution based data we need further studies to see if over use of USG based imaging for any thyroid swelling is responsible for an apparent increase in the number of thyroid cancer cases.

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On the Classification of TI-RADS and Stratification of Signs of Thyroid Cancer According to Ultrasound Data

Medical Visualization ◽

10.24835/1607-0763-2017-5-29-38 ◽

2017 ◽

pp. 29-38 ◽

Cited By ~ 1

Author(s):

E. P. Fisenko ◽

J. P. Sich ◽

N. N. Vetsheva

Keyword(s):

Thyroid Cancer ◽

Retrospective Analysis ◽

Thyroid Nodules ◽

Thyroid Ultrasound ◽

High Reproducibility ◽

System 1

Objective:a comparative “blind” assessment of the thyroid nodules identified by ultrasound, according to the TI-RADS scale in various modifications.Materials and methods.Retrospective analysis of 149 echograms of thyroid nodules by three independent experts was performed (the experience of ultrasound of thyroid ultrasound for more than 7 years).Results. In solid nodules, high-specific large (more than 94%) and small (more than 90%) ultrasound signs of thyroid cancer have been identified. The nodes are stratified according to the TI-RADS system: 1 – in the modification J.Y. Kwak et al. (2011), 2 – according to the proposed system, taking into account small ultrasound signs of thyroid cancer. High reproducibility of both systems are obtained. In the first system 13.7% of cancer nodes fell into the category of TI- RADS 3 (benign formations), in the second system only 5% of cancers fell into the category of TI-RADS 3, which is important for biopsy selection. The sensitivity of the first system was TI-RADS 82.05%, of the second system – 94.87%.Conclusions.Classification of TI-RADS can be used to interpret the ultrasound results of thyroid nodules, taking into account both the main large and small ultrasound signs of cancer. For its validation in our country, it is necessary to further broad discussion of the proposed TI-RADS system.

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QUANTITATIVE AND QUALITATIVE CHARACTERISTICS OF METASTASES IN REGIONAL LYMPH NODES - RISK FACTORS FOR THE RECURRENCE OF PAPILLARY THYROID CANCER IN CHILDREN AND ADOLESCENTS

Problems in oncology ◽

10.37469/0507-3758-2018-64-2-159-165 ◽

2018 ◽

Vol 64 (2) ◽

pp. 159-165

Author(s):

Mikhail Fridman ◽

Svetlana Mankovskaya ◽

Olga Krasko

Keyword(s):

Risk Factors ◽

Thyroid Cancer ◽

Lymph Nodes ◽

Children And Adolescents ◽

Papillary Thyroid Cancer ◽

Papillary Thyroid ◽

Regional Lymph Nodes ◽

Cancer In Children ◽

Qualitative Characteristics

Among the factors determining the relapse/persistence of papillary thyroid cancer in children and adolescents the most important are the age of the patient (p= 0.003), the presence of concomitant background pathology (p

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