As with breast and prostate cancer , cancers of the thyroid low grade are over-diagnosed and, therefore, over-processed, say the authors of a study published in the British Medical Journal.
In 30 years, the number of thyroidectomy has tripled in the United States, from 3.6 per 100 000 population in 1973 to 11.6 per 100,000 in 2009. In France, the annual number of new cases of thyroid cancer is estimated to be approximately 4000, an incidence that increases from 2 to 6% per year.
This strong increase is due to improved techniques for detecting anomalies. “Techniques for high-tech imaging such as ultrasound, CT and MRI can detect very small thyroid nodules, many of which turn out to be papillary thyroid cancer develops slowly, says Juan Pablo Brito. This exposes patients to unnecessary and dangerous treatments, inconsistent with their prognosis. ”
Resection of all or part of the thyroid gland is an expensive procedure that creates a risk of complications such as lower calcium concentrations and recurrent laryngeal nerve damage, leading to voice problems.
In fact, besides the risk inherent in any surgery procedure, the removal of the thyroid is very difficult because of the presence of the recurrent laryngeal nerve just behind the glands. However, it is not uncommon that this nerve is injured the waning of thyroidectomy, with consequences on the patient’s voice. Moreover, the procedure involves, subsequently taking thyroxine (or T4) to overcome the lack of secretion of this hormone, and very often, the iodine 131 taken to ensure that the remains of cancerous thyroid tissue did not migrate elsewhere in the body.
For Dr. Brito, “uncertainty about the benefits and risks of immediate intervention of papillary thyroid cancers of low grade should encourage physicians to discuss with their patients the therapeutic decision to be taken to ensure that the treatment is consistent with the state of research and patient expectations. ”
To dramatize the diagnosis of this type of cancer, the prognosis is actually very good (99% survival at 20 years), the researcher proposes a new term such as “micropapillary lesions of indolent course (microPLIC) “. This would allow patients to choose between active surveillance generally sufficient for these cancers, and a fairly aggressive immediate intervention.
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