TUESDAY, Aug. 7, 2018 — Overtreatment of thyroid cancers is common, according to a perspective article published in the July 25 issue of the New England Journal of Medicine.
Noting that mortality due to thyroid cancer has remained stable despite the dramatic increase in incidence, indicating widespread overdiagnosis, H. Gilbert Welch, M.D., M.P.H., from the Dartmouth Institute for Health Policy and Clinical Practice in Hanover, N.H., and Gerard M. Doherty, M.D., from Brigham and Women’s Hospital in Boston, discuss efforts to reduce overtreatment.
The researchers note that they support active surveillance for some patients with small papillary cancers and that the choice between total thyroidectomy and lobectomy has little effect on the risk of thyroid cancer mortality. However, the rate of total thyroidectomy has increased faster than that of lobectomy. As patients are unlikely to have preferences for which operative strategy to follow, the increase is likely due to physician preferences. The rationale for the persistence of total thyroidectomy may be due to insufficient knowledge and motivation, with surgeons underestimating complication rates, especially if they rarely perform the surgery. Other surgeons may choose to follow long-standing practice conventions for total thyroidectomy. De-intensifying care may increase anxiety among patients, but primary care practitioners can help by educating patients.
“Active surveillance should be an option available for patients with small papillary cancers,” the authors write. “And for those who prefer intervention, or whose disease warrants it, we should make it clear that lobectomy is often the best choice.”
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Posted: August 2018
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