Not all thyroid cancer is the same.
For some it's everything - the game changer.
For many it's a readily survivable kick in the teeth.
But perhaps for many more it is an avoidable, unnecessary harm, caused by overdiagnosis and overtreatment.
A recent report in the New England Journal of Medicine further highlights that many of the thyroid cancers that are currently detected are small, and are unlikely to cause ill health. In fact over-enthusiastic (though well-meaning) treatment may be causing more harm for many than if it were left alone, or better still, if it was never known about.
It's attracted attention in the public press too 1, 2, 3, etc
Overdiagnosis is a growing issue, highlighted for example in the BMJ and Dr Welch's thought-provoking book Overdiagnosed.
We are some way off knowing how best to investigate for thyroid cancer, particularly now that it's clear that harm can arise from over-investigating.
Rightly or wrongly, I advise medical students "don't order an ultrasound of a thyroid, unless you are intending to annoy me". Whilst this is tongue-in-cheek, it is intended to get the point across, that unless there is good reason to investigate, don't do so, as you run the very real risk of causing harm. Most of us are better off not knowing that we harbour small, asymptomatic thyroid nodules.
With more knowledge like this latest NEJM report, the best approach will hopefully become clear.
For some it's everything - the game changer.
For many it's a readily survivable kick in the teeth.
But perhaps for many more it is an avoidable, unnecessary harm, caused by overdiagnosis and overtreatment.
A recent report in the New England Journal of Medicine further highlights that many of the thyroid cancers that are currently detected are small, and are unlikely to cause ill health. In fact over-enthusiastic (though well-meaning) treatment may be causing more harm for many than if it were left alone, or better still, if it was never known about.
It's attracted attention in the public press too 1, 2, 3, etc
Overdiagnosis is a growing issue, highlighted for example in the BMJ and Dr Welch's thought-provoking book Overdiagnosed.
We are some way off knowing how best to investigate for thyroid cancer, particularly now that it's clear that harm can arise from over-investigating.
Rightly or wrongly, I advise medical students "don't order an ultrasound of a thyroid, unless you are intending to annoy me". Whilst this is tongue-in-cheek, it is intended to get the point across, that unless there is good reason to investigate, don't do so, as you run the very real risk of causing harm. Most of us are better off not knowing that we harbour small, asymptomatic thyroid nodules.
With more knowledge like this latest NEJM report, the best approach will hopefully become clear.
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