Thyroid cancer cases are on the rise. The National Cancer Institute estimates that there will be around 54,000 new cases diagnosed in 2018. While this is not the largest number of cases of a type of cancer, the rate at which thyroid cancer has increased since 1975 has tripled. Most sources agree that thyroid cancer is growing at the fastest rate of all types of cancer. Why? Who gets thyroid cancer? How is the best way to treat thyroid cancer?
Why some people get thyroid cancer is not certain. While there are some heredity types of thyroid cancer, most thyroid cancer patients do not have a family history of the disease. That said, having a first degree relative ( parent, brother, sister or child ) who has had thyroid cancer increases the risk of one having thyroid cancer. In a percentage of patients with medullary thyroid cancer, an inherited abnormal gene is to blame. It might be prudent if one has a family history of medullary thyroid cancer to have gene testing, although having the gene does not necessarily mean that this will definitely lead to the development of thyroid cancer. The following statements are purely my thoughts on this, and it is just speculation on my part, but I believe that even if one has the gene for thyroid cancer development, there has to be something in the person's environment to turn it on- to flip the switch for the development of thyroid cancer, so to speak. Whether this is exposure to a toxin in our environment, too much radiation exposure as a child, or something else not yet discovered. There is much more that can be said about gene involvement in thyroid cancer. I am going to stop here, but the American Cancer Society has much more information on this, if anyone is interested.
So what about the connection of radiation exposure as a child, and the development of thyroid cancer as an adult? A recent article in the publication, Clinical Thyroidology, discusses the results of twelve studies of people under the age of 20 who were exposed to radiation. A significant number of these patients developed thyroid cancer. The average age of the exposure to radiation was 5 years old, and the average age of getting a thyroid cancer diagnosis was 41 years old. The following statistics give me pause: the increased risk of getting thyroid cancer after radiation exposure could occur in as few as 5 to 10 years after exposure. BUT for some patients, the risk may persist for 50 years!
You may be wondering what types of radiation these children were exposed to, and why. Besides dental x-rays with no protective shielding of the thyroid gland, in the '50s, and '60s, children were sometimes treated with radiation for certain skin conditions or enlarged tonsils or adenoids. There were also certain shoe stores that routinely used x-rays to measure a child's foot to get the proper sized shoe. Also, as you might expect, there are higher rates of thyroid cancer in adults who were exposed to radioactivity ( as children) from the Chernobyl accident. In the western parts of the United States, where nuclear weapons were tested in the '50s, there may be higher rates of thyroid cancer , but there are no definitive studies to cite as yet. Just something to consider...
Now for the " Who" in the equation of who is more likely to get thyroid cancer. Women, for reasons unknown, are three times more likely to have thyroid cancer than men. The risk factor for women having thyroid cancer peaks at the ages of 40 to 50, while in men, the age is 60 to 70. Anyone, at any age, can have thyroid cancer, though.
I recently read an article in the magazine, Cure, which asked the question " Is thyroid cancer being over diagnosed and over treated? I will quickly give you the 411 on the author's thoughts on this, and then I will tell you how I feel. Not everyone who has thyroid cancer opts for surgery. If the cancer is encapsulated, and the tumor is less than one centimeter, some people- with the advice and care of their physician- opt for " active surveillance". Active surveillance includes frequent ultrasounds, blood work and office visits. The ultrasounds usually occur every six months, on average. If it is found, by ultrasound, that the tumor(s) are growing, then the patient would have a partial or full thyroidectomy.
In full disclosure, I will tell you now that my tumors, plural, were unencapsulated, and had emptied out into my neck bed. ( for those who like medical terminology, like I do, one tumor was 2 centimeters in size, lymphatic/vascular invasion present,unencapsulated tumors, diffusely infiltrative). For those who do not like medical terminology, I was up sh**t creek, basically. After my total thyroidectomy, the final biopsy showed that two of my parathyroids were also cancerous, and were removed.
My surgeon told me that I had had thyroid cancer for a long time. Over the years, my blood work would look a little wonky, but was mostly considered acceptable. I had been seeing this one physician for five years, and he never did an ultrasound or a biopsy. He told me that the reason I felt so bad was probably due to stress. I knew that I needed to get a second opinion, and that something was wrong. I found a new physician, and she found my thyroid cancer with an ultrasound led biopsy. FYI: for those of you getting a thyroid cancer biopsy, PLEASE make sure that it is done with an ultrasound technician in the room helping the physician as she/he takes the samples. Otherwise, I think, it is a little like looking for a needle in a haystack. A little haystack, but still.
For the above stated reasons, I would be very nervous about doing the whole " active surveillance" thing. It might work for some people, but when I found out that I had thyroid cancer, I wanted that monster out right away. If someone chooses active surveillance of their thyroid cancer, I would make sure that all appointments are kept, and that any unusual symptoms are reported ASAP to the physician.
So, in my opinion, is thyroid cancer over- diagnosed? No. Is thyroid cancer being over-treated( meaning surgery, I assume). No, again. The causes are mostly speculative, but some are fairly easy to connect the dots to. As i said, this is just my opinion. One thing that everyone should agree on is that a thyroid cancer patient needs to do their homework. Find out the type of thyroid cancer that they have, devise a treatment plan with their doctor that would work best for them, and keep a notebook of all medical records- procedures and tests.
