Radioactive iodine treatment for thyroid cancer may adversely affect ovarian reserve


Women with differentiated thyroid cancer treated with radioactive iodine ablation experienced decreased anti-Müllerian hormone levels 3 months after treatment with only partial recovery at 1 year after treatment, which may suggest an adverse effect of radioactive iodine in women of reproductive age, according to study findings.

“Many of the subjects treated for differentiated thyroid cancer are women in their reproductive years, often before having given birth for the first time,” Karen M. Tordjman, MD, director of the endocrine clinics at the Institute of Endocrinology at the Tel Aviv Sourasky Medical Center in Israel, told Endocrine Today. “The findings of this study suggest that radioiodine, given as part of the initial treatment for this cancer, could have a negative impact on the future reproductive potential of some of these women. The concerns raised by this study support the current approach that radioactive iodine ablative treatment be reserved to subjects in whom it offers a clear survival or disease-free advantage.”

Tordjman and colleagues evaluated data on 24 women (mean age, 34.3 years) with differentiated thyroid cancer who underwent radioactive iodine (RAI) ablation to determine the effect of RAI treatment on ovarian reserve by measuring the concentration of anti-Müllerian hormone (AMH) 1 year after treatment. A subgroup of five women (mean age, 33.6 years) who underwent RAI ablation for Graves’ disease were also evaluated. AMH levels were measured at baseline and 3, 6 and 12 months after RAI. Baseline AMH levels were 3.2 ng/mL in the differentiated thyroid cancer group and 2.6 ng/mL in the Graves’ disease subgroup.

In participants with differentiated thyroid cancer, baseline AMH level decreased by 49% at 3 months after RAI treatment from 3.25 ng/mL to 1.9 ng/mL (P = .001). In the entire cohort, some recovery in AMH levels was observed, but plateaued at 9 months; at 1-year, AMH concentrations were 32% lower compared with baseline (P = .016).

When the median age of 35 years was used as a cutoff, participants aged at least 35 years were more likely to experience a reduction in AMH at 3 months compared with younger participants (P = .007).

In participants with Graves’ disease, RAI ablation had no treatment effect on AMH levels.

Amenorrhea lasting up to 4 months was reported by two participants, and three reported irregular periods for at least 1 year after treatment. Menstrual irregularities were reported by 19.2% of participants with differentiated thyroid cancer.

“As this is a pilot study that followed a limited number of subjects for only a year, a larger and more prolonged prospective study is needed to confirm these preliminary data, and using fertility outcomes as hard endpoints, to determine if this effect on anti-Müllerian hormone translates into decreased fertility,” Tordjman said. “In the meantime, the authors suggest that serum levels of anti-Müllerian hormone could serve as an ancillary tool when planning radioiodine ablative therapy for women over the age of 35 who desire pregnancy.”

Extra-thyroid extension increases recurrence rates in differentiated thyroid cancer


Extra-thyroid extension increases the risk for disease recurrence in adults with differentiated thyroid cancer compared with those without extension, but overall mortality is higher in those without extension, study data show.

Eyal Robenshtok, MD, of the Endocrine Institute at Rabin Medical Center-Beilinson Hospital and the Sackler Faculty of Medicine at Tel Aviv University in Israel, Talia Diker-Cohen, MD, PhD, of the Institute of Endocrinology, Diabetes and Metabolism at Rabin Medical Center-Beilinson Hospital in Israel, and colleagues conducted a systematic review and meta-analysis of 13 studies published between 1966 and June 2017 with a median follow-up of 86 months that included 23,816 adults with differentiated thyroid cancer to determine the effect of minimal extra-thyroid extension on disease outcome. Participants with and without lymph node metastases were included. Recurrent or persistent disease at the end of follow-up, disease-related mortality and overall mortality were the primary outcomes.

Among participants without lymph node metastases, the risk for recurrence was increased among those with minimal extra-thyroid extension compared with those without extension (OR = 1.73; 95% CI, 1.03-2.92). Participants with tumor extension had a higher absolute risk for recurrence compared with those without extension (3.5% vs. 2.2%; P = .04). Further, the risk for recurrence was higher in participants with extension who underwent lobectomy alone compared with those without extension who underwent lobectomy alone (6.9% vs. 4.2%; P = .3).

Among a combination of participants with and without lymph node metastases, the risk for recurrence was higher among those with extension compared with those without extension (OR = 1.82; 95% CI, 1.14-2.91). The absolute risk for recurrence was also higher in those with extension compared with those without extension (7% vs. 6.2%; P = .01). In participants with or without lymph node metastases who underwent total thyroidectomy or radioactive iodine ablation, the risk for recurrence was higher in those with extension compared with those without extension (4.8% vs. 2.3%; P = .06).

Among participants with micropapillary thyroid carcinoma, minimal extra-thyroid extension had no significant effect on recurrence rates.

Participants with extension had lower overall mortality compared with those without extension (8.7% vs. 9.8%).

“For many years, minimal extra-thyroid extension was regarded as an indication for total thyroidectomy and radioiodine ablation, due to fear of high risk for recurrence,” Robenshtok told Endocrine Today. “Our study strongly demonstrates that though the risk is slightly higher, it is still within the low-risk category. This implies that patients with minimal extra-thyroid extension with lymph node involvement may be treated less aggressively — either without radioiodine or with lobectomy alone. This approach is in line with the current paradigm of less-aggressive treatment in patients with low-risk thyroid cancer, balancing the benefit of treatment with treatment-related morbidity. We need to look at the patient as a whole, looking to cure disease while preserving optimal quality of life. Given how common minimal extra-thyroid extension is, this data may have a substantial effect on treatment recommendations.”

Fracture incidence in thyroid cancer linked to levothyroxine dose


Adults with thyroid cancer taking less than 115 µg per day or at least 145 µg per day of levothyroxine after thyroidectomy or radioiodine ablation therapy had an increased risk for fractures compared with those taking 115 to 144 µg per day, according to study findings.

Youngmin Park, MD, MPH, of the department of family medicine at the National Health Insurance Service Ilsan Hospital in Korea, and colleagues evaluated data from the Korean National Health Insurance database on 185,956 adults with thyroid cancer and matched comparison subjects (controls) to determine fracture incidence among them and associations between levothyroxine use and fracture risk. Participants had a mean age of 46.8 years and 82.8% were women. Follow-up was a mean of 3.96 years.

Participants with thyroid cancer were divided into groups based on levothyroxine dosage quartiles: first (< 115 µg per day), second (115-144 µg per day), third (145-169 µg per day) and fourth ( 170 µg per day).

Over follow-up, 0.56% of the thyroid cancer group and 0.58% of the control group experienced a fracture. The risk for osteoporotic fracture overall was not elevated in the thyroid cancer group compared with controls. Participants receiving the highest dose of levothyroxine had a higher risk for fracture compared with the other doses (HR = 1.25; 95% CI, 1.07-1.45), and those receiving the second quartile dose had a lower risk (HR = 0.71; 95% CI, 0.59-0.84).

When the second quartile dose was used as reference, the risk for fracture was increased in those in the first quartile (adjusted HR = 1.31; 95% CI, 1.08-1.59), third quartile (adjusted HR = 1.5; 95% CI, 1.26-1.79) and fourth quartile (adjusted HR = 1.79; 95% CI, 1.51-2.13).

“Our study shows that both high and low dosages of levothyroxine treatment [are] associated with a higher risk of fractures in a J-shaped dose-dependent manner in post-thyroidectomy patients,” the researchers wrote. “Future studies are needed to determine how to optimize TSH suppression and how to screen and manage fracture risk.” – by Amber Cox

Sore throat, swollen glands linked to thyroid cancer


https://speciality.medicaldialogues.in/sore-throat-swollen-glands-linked-to-thyroid-cancer/

Thyroid Cancer Epidemic Caused by Misinformation, Not Cancer


Thyroid Cancer Epidemic Caused by Misinformation, Not Cancer

Did you know the vast majority of thyroid cancer diagnoses are FALSE? And yet, the vast majority go ahead and get ‘treated’ anyway, with total removal of the gland, radiation and life long hormone replacement.

Any diagnosis of cancer can be highly traumatic. Given the conventionally held view that screen detected, early-stage lesions or tumors will inevitably grow into invasive, lethal cancers without conventional treatment, receiving a diagnosis represents a psychic wound with adverse physiological consequences that can, in and of itself, injure the patient and reduce their chances of success in treatment.

This is all the more clear in the case of overdiagnosis, where a patient’s condition is misinterpreted to be potentially fatal, when in fact, the natural history of the lesion or tumor in question is that when left untreated it will never do harm, often producing no symptoms in the life of the patient; or, where it does produce symptoms, the patient does not experience significant disability or death before other causes intervene to take their life. There is also the overarching reality that the health risks associated with aggressive conventional treatment of early-stage ‘cancers’ often results in the ‘solution’ being far more harmful than the condition being treated.

The very real trauma (literally “wound”) of cancer diagnosis can no longer be considered a strictly theoretical concern. A recent study published in the New England Journal of Medicinefound that, based on data from more than 6 million Swedes 30 and older between 1991-2006,a positive diagnosis of cancer increased the risk of suicide up to 16 fold and the risk of heart-related death up to 26.9 fold during the first week following diagnosis versus those who were cancer free.  The association was prognosis correlated: the more severe and treatment resistant the condition (e.g. brain cancer was highest), the higher the increase in both suicide and heart-related death. Obviously the implications are astounding, especially considering that a misdiagnosis or overdiagnosis can have lethal consequences, putting the medical system in a position of responsibility for doing profound harm by applying screening programs to asymptomatic and otherwise healthy individuals, who are not given the opportunity of informed consent about the real risks associated with these so-called ‘preventive’ programs.

It should be noted that there are mechanisms available to explain this disturbing association between the trauma of diagnosis and increased risk for death. We now know that the secretion of adrenaline, associated with stress and the fight-or-flight response, actually activates genetic processes within cancer cells that make them more treatment resistant.1Stress associated excess cortisol levels will also down-regulate cancer immunosurvillence in certain individuals. In other words, this is not some ‘magical’ mind-body phenomena, rather, we now know how placebo/nocebo factors related to the latent symbolism and signification of the ritual of clinical interactions and the patient-doctor relationship gear into real physiological processes, whose adverse health consequences have been characterized down to a molecular level.

We have spent significant time researching and writing on the problem of overdiagonsis in the case of breast cancer, where it is now known 1.3 million US women were overdiagnosed for breast cancer over the past 30 years, due to misinformation driven breast screening programs. These women, many of whom were diagnosed with ductal carcinoma in situ (DCIS), a condition know believed to be essentially benign, underwent unnecessary mastectomies, lumpectomies, radiation and chemotherapy treatments, resulting in massive psychic, financial, and health crises that should never have transpired. Many of these women suffer from a Stockholm syndrome-like state (victim identifies with aggressor), participating in promoting unnecessary screenings and treatments to women through breast cancer industry funded cause-marketing campaigns as part of their ‘healing process’ — never quite appreciating the nature of their trauma, while contributing to reproducing the same violation in other women while thinking they are helping to ‘save’ lives.

The Thyroid Cancer Epidemic Is Being Caused By the Medical System

Thyroid cancer is another epidemic level condition that participates in this truly horrific paradigm of overdiagnosis and overtreatment. A recent study published in the American Journal of Clinical Pathology titled, “revisiting overdiagnosis and fatality in thyroid cancer,” reveals that between the years 1975-1999 incidences of nonfatal forms of thyroid cancer rose (mostly due to papillary carcinomas) dramatically without the concomitant expected decrease in incidences of fatal forms of thyroid cancer – a classical indication of overdiagnosis.  In other words, were these thyroid cancer screenings detecting early-stage cancers that were destined to progress to more lethal forms, the statistics would show that along with dramatically expanding rise in early state thyroid cancer detection and treatment a corresponding decline in late stage, more lethal forms. The clear absence of this relationship indicates that like with early stage ‘breast cancer’ there is an epidemic of inappropriate thyroid cancer diagnoses and victims of iatrogenic harm associated with their ‘treatment.’

The authors of the study concluded: “The results of this study support the notion that many thyroid cancers are part of a reservoir of nonfatal tumors that are increasingly being overdetected and overdiagnosed.”

A clear perspective on the problem is available through the National Cancer Institute’s U.S. Thyroid Cancer Diagnosis and Mortality statistics from 1975-2011. In the graph below you find new thyroid cancer cases have been rising on average 5.5% each year over 2002-2011, with death rates actually rising on average 0.9% each year over 2001-2010. We would expect to find the opposite trend if these early diagnosed and treated cases were actually cancer.

Image source: NCI

Even more cognitively dissonant is their graph of the seemingly successful 5-year survival rate, boldly declaring 97.8% of diagnosed cases between 2004-2010 survived 5 years, falsely implying that their lives were benefited or even saved by being overdiagnosed and overtreated.  If any of these patients died at year 6 from an unnecessary treatment related cause, it is common practice to consider it a separate disease process, further generating the illusion that iatrogenic harm had not been done and of the success of the screenings and treatments being employed.

Image source: NCI

The heart of the matter is the false characterization of papillary lesions of the thyroid as lethal cancers. An insightful editorial published in Future Oncology titled “Papillary lesions of indolent course: reducing the overdiagnosis of indolent papillary thyroid cancer and unnecessary treatement,” opens with the following salient quote:

“No new risk factors, but one, can completely explain the surge of [small papillary cancer] lesions: the exponential increase in the use of diagnostic imaging”

The article goes on to describe “a worldwide epidemic of thyroid cancer without a corresponding increase in thyroid cancer deaths,” and explains, “The majority of these cancers are small papillary cancers, the most indolent type of thyroid cancer, with a mortality of less than 1% after 20 years of postsurgical follow-up.” A study is referenced that “suggested that if all thyroid glands were subject to millimeter- thick cuts, the pathologist would detect minute or microscopic thyroid cancers in everyone.”

Ultimately, the condition should be redefined as benign:

“Observational studies have strongly suggested that treatment does not change the indolent course of small papillary lesions, which do not evolve to cause metastatic disease or death. Owing to the excellent prognosis associated with small papillary thyroid cancers, it may be reasonable to put them in the same category as has been suggested for ductal carcinoma in situ of the breast renaming them as papillary lesions of indolent course (PLICs)”

Despite this indolent nature, the so-called ‘standard of care’ is total removal of the thyroid (thyroidectomy) for the treatment of these small papillary lesions (‘cancers’), followed by often unwarranted radiation treatment (a cancer causing treatment) and lifelong, mostly synthetic, thyroid hormone replacement, which itself may carry increased risk of lung cancer.

This notion that many screen-detected cancers, including breast, prostate, lung and thyroid, should be entirely reclassified as benign or of exceedingly low concern, received great support last year with the publication of an National Cancer Institute commissioned expert review on the topic that we reported on in our article: “Millions Wrongly Treated for ‘Cancer,’ National Cancer Institute Panel Confirms.” The information, however, is not getting to the ‘front lines’ of this war soon enough. The collateral damage from the 40-year declared War on Cancer is as real in terms of human suffering and wide-reaching as any major historical global military conflict, and literally depends on diagnostics and interventions gleaned from the most deadly and cruel weapons humans have created: radioisotopes (radiation therapy) and chemical weapons (chemotherapy).

The editorial on thyroid cancer overdiagnosis suggests that one way this false epidemic can be mitigated on the front end is through reducing overtesting: “Overtesting is the use of a test unlikely to produce net benefit for the patient.”  The general implications are clear. Information gleaned from modern diagnostic technologies is being misinterpreted, and in some cases misused to benefit a burgeoning biomedical industry that thrives both on the sales of expensive technologies and highly profitable treatments and follow-up care.

Clearly a more nuanced view of cancer in general needs to be instituted to protect against the possibility of mass iatrogenic collateral damage associated with overdiagnosis and subsequent overtreatment.  The big ‘C’ – Cancer — is not a monolithic entity, or some  irrepressible juggernaut like force of lethality. While there are cancers that take on aggressive, treatment resistant form, these are the vast minority relative to the submerged iceberg of non-lethal forms, some of which can be treated with a combination of anti-cancer foods, alternative therapies including detoxificaiton, mind-body practices and traditional plant medicine, as well as through enhancing the body’s immunosurveillance. In some cases, such as so-called pre-cervical cancer associated with HPV infection, watchful waiting – essentially doing nothing to intervene – results in remission in the vast majority of time. Even so-called invasive breast cancer has been found to be reabsorbed by the body in some cases, according to a Lancet Oncology study. And then there is the fact that conventional cancer diagnosis and treatment methods are almost all invariably carcinogenic – an irony that can not be over appreciated.

Should we be surprised at these results? Perhaps not so if we better understand cancer as an adaptive response to radically altered environmental conditions within the body, which include infections, suboptimal nutrition, toxic and toxicant exposures, and a wide range of incompatible or outright damaging nutritional, environmental and lifestyle changes associated with the post-industrial world.  Reducing unnecessary exposures to biomedical diagnostic technologies and highly toxic treatments should be the first step in cancer prevention and not treating the body as if it were designed to be a cancer time bomb ready to explode, rather than a miraculous self-healing meta-organism that is destroying abnormal cells on a moment to moment basis when treated in accordance with its highly intelligent design and requirements for clean food, air, water, and balance in mind, body and soul.

Note: For relevant research on both the harms associated with conventional thyroid cancer treatment, and potential natural/integrative alternatives, view our Thyroid Cancer research page on the topic.

Thyroid Cancer Epidemic of Overdiagnosis


Thyroid Cancer Epidemic of Overdiagnosis

Thyroid Cancer Epidemic of Overdiagnosis

The last 40 years have shown triple the incidence of thyroid cancer in women, yet the mortality rate has remained the same.  Why are physicians so quick to diagnose women with thyroid cancer?

American Idol Alum Jax Cole

The American Idol finalist Alum Jax Cole announced that she underwent thyroid surgery in April after discovering a “lump in her neck”.  She is now receiving radiation treatments, presumably radioactive iodine (I-131), after the finding of thyroid cancer at surgery.(1-3)

Alum Jax Cole Thyroid Cancer Epidemic of Overdiagnosis

An Epidemic of Overdiagnosis of Thyroid Cancer  In Women

According to Dr Gilbert Welch in 2014 Otolaryngology, there is an epidemic of overdiagnosis of thyroid cancer in young women.(4)

Since 1975, the incidence of thyroid cancer in women has more than tripled from  6.5 to 21.4 per 100,000 women, mostly from papillary cancer.

However, the “mortality rate from thyroid cancer was stable between 1975 and 2009 (approximately 0.5 deaths per 100 000).”  

In other words, mortality from thyroid cancer did not increase, even though the incidence tripled.  If this was real cancer, one would expect increase in mortality numbers.  There was none.

Dr Welch concludes:

“There is an ongoing epidemic of thyroid cancer in the United States. The epidemiology of the increased incidence, however, suggests that it is not an epidemic of disease but rather an epidemic of diagnosis. The problem is particularly acute for women, who have lower autopsy prevalence of thyroid cancer than men but higher cancer detection rates by a 3:1 ratio.”

Alum Jax Cole Thyroid Cancer Epidemic of Overdiagnosis

Above Chart shows thyroid cancer rising incidence females (GREEN Arrow), while thyroid cancer mortality is unchanged (flat line RED Arrow). Chart courtesy of Davies, Louise, and H. Gilbert Welch. (4) “Current thyroid cancer trends in the United States.” JAMA Otolaryngology–Head & Neck Surgery 140.4 (2014): 317-322.

Dr Robert Udelsman reported in Thyroid 2014, on”The Epidemic of Thyroid Cancer in the United States”. (16)   He says:

“The increased detection of thyroid cancer results in surgery and radioactive thyroid treatment that may be of limited benefit.”

“The autopsy prevalence rate of occult thyroid cancer in the Finnish population is 35.6%, suggesting that thyroid cancer is both common and clinically insignificant for the vast majority of individuals”

“It is likely that the majority of diagnosed thyroid cancer patients will not benefit from surgical and/or adjuvant interventions. “

Pathologists:  Many Thyroid Cancers Should be Reclassified

Dr Nikiforov writes in JAMA Oncology 2016 that many thyroid cancers are really not cancer and should be reclassified.(6)  An example is the encapsulated follicular variant of papillary thyroid carcinoma.  These cases are treated as having conventional thyroid cancer, yet they are not really cancer,  Dr Nikiforov says this type of pathology does not require radioactive iodine after surgery.

In 2016, Dr Lester Thompson reviews 94 cases of thyroid cancer with the pathology diagnosis of “Encapsulated follicular papillary thyroid carcinoma”. (17)  Because of the indolent nature, they recommended changing the pathology classification to Noninvasive Follicular Thyroid Neoplasm”  Dr Lester  Thompson went on to say: These are “exceedingly indolent tumors, best managed conservatively by lobectomy or thyroidectomy alone, without radioablative iodine or suppression therapy.”(17)

Thyroid Cancer: What are the Drivers of Overdiagnosis:

1)  Advent of High Resolution Ultrasound imaging and thyroid screening programs which detect ever smaller “abnormalities”.

2) Commercial and professional vested interests. Hospitals make more money if they do more thyroid biopsies, thyroidectomies, and radioactive iodine treatments.  Thyroidectomy creates a patient on thyroid medicine for life.

3) Conflicted panels such as the American Thyroid Association, and the Endocrine Society write guidelines that expand disease definitions and encourage overdiagnosis.

4) Malpractice Litigation punishes underdiagnosis but not overdiagnosis.

5) Health system incentives encourage more testing and more treatment.

6) Cultural beliefs that more is better; faith in early detection unmodified by its risks. (12)  Paraphrased from Ray Moynihan. “Preventing overdiagnosis how to stop harming the healthy .” Bmj (2012).

Medical Iatrogenesis in Women

Dr. Adriane Fugh-Berman states very clearly,  “there is a tradition in U.S. medicine of excessive medical and surgical interventions on women”.(14)

Over-Diagnosis of “Hysteria” in Women.

Perhaps one of the early examples of medical iatrogenesis in women occurred in the 1800’s in Paris with the over-diagnosis of “Hysteria” by Dr Charcot   Dr. Martin Charcot of the Paris hospital La Salpetriere diagnosed, ten “Hysterical” women each day,  The number of women diagnosed as “Hysteria” increased 17-fold from  from 1% in 1841 to 17% in 1883.(13,14)

DES  Diethyl-Stilbestrol

A more recent historical example of medical iatrogenesis in women is the 1938 story of DES (Diethylstilbestrol) the first synthetic hormone replacement drug.  This carcinogenic monster hormone was approved by the FDA and given to millions of women from 1940 until it was banned in 1975 because it was shown carcinogenic.  The first report of cervical cancer in the daughters of DES treated women was published in April 1971 in the New England Journal of Medicine.(15)

Premarin

Our next example of medical iatrogenesis in women is Premarin, a horse estrogen isolated from the urine of pregnant horses.   Available since FDA approval in 1942, Premarin has caused an estimated 15,000 cases of endometrial cancer, representing the largest epidemic of serious iatrogenic disease ever reported.(15)    One might think this would be the end of any drug.   However Premarin was promptly rehabilitated with the addition of another synthetic hormone, a progestin, to prevent endometrial cancer.  Thus, in 1995, Prempro was born, a synthetic hormone pill containing both Premarin (the horse estrogen) and Provera (the progestin).  Again, this was FDA approved,  thought safe and handed out freely to millions of women.

Prempro

Our next example of medical iatrogenesis in women is Prempro , the combination of Premarin with Provera (medroxyprogersterone) found to cause breast cancer and heart disease.  Four large scale studies showed increased breast cancer and heart disease from this estrogen-progestin combination pill.  The  Breast Cancer Detection Demonstration Project, published in 2000, showed an eight fold increase in breast cancer for estrogen-progestin users.(15)  The Swedish Record Review, published in 1996, had a fourfold increase in breast cancer with progestin use.(15)  The Million Woman study, published in Lancet in 2003, had a fourfold increase in breast cancer for estrogen-progestin combination users compared to estrogen alone users.(15)  Finally in 2002, JAMA published the Women’s Health Initiative (WHI), an NIH funded study terminated early because of increased breast cancer and heart disease in the estrogen-progestin users.(15)  Incredibly, the medical system is still dispensing this discredited drug to women.

SSRI Antidepressants Shown to be No More Effective Than Placebo

The next example medial iatrogeneiss in women is SSRI antidepressant drugs that were shown to have little benefit for patients with mild to moderate depression.  The benefits of SSRI drugs are equivalent to placebo pills.(15).  Adverse side effects include sexual dysfunction, movement disorders, increased suicidality, mania and violence and withdrawal effects.  In spite of this, the discredited SSRI drugs are still being dispensed freely to millions of women.

Mistreatment of Women by the Medical System – Excessive Hysterectomies  

The National Women’s Health Network has written extensively on the overuse of hysterectomies.  Ernst Bartsich, M.D., a  surgeon at Cornell in New York. says ” Of the 617,000 hysterectomies performed annually, “from 76 to 85 percent” may be unnecessary. “(CNN)  Thus representing another example of mistreatment of women by the medical system.(15)

More Discredited Treatments Used on Women: 

Radical MastectomyA disfiguring operation which provided no benefit compared to lesser procedures such as lumpectomy.

Bone Marrow Transplantation for Breast CancerWhich was abandoned when studies showed it offered no benefit.(Welch BMJ 2002)

Kyphoplasty for Osteoporotic FractureWas discredited when studies found no benefit compared to a sham procedure

Arthroscopy for OsteoarthritisWas abandoned after studies found no benefit compared to conservative treatment.

Screening mammogramsFor under 50 age women offers more harm than benefit.

Conclusion:

Drs Welch, Udelsman, Nikiforov and Moynihan have come forward to alert the public to the “Epidemic of Overdiagnosis of Thyroid Cancer”,  a form of medical iatrogenesis in young women.   Since Alum Jax Cole’s pathology report was not made public, we don’t know if her particular case was overdiagnosis.

Based on the epidemiology data alone, many young women with thyroid cancer are overdiagnosed.  How many?  For every 43 women diagnosed with thyroid cancer, one (2.3%) will die from metastatic thyroid cancer, and the other 42 (97.7%) will eventually die from other causes.  About 1,070 women die from thyroid cancer annually. This number has not changed over 30 years in spite of aggressive detection and treatment.  For comparison, about 41,000 women die from breast cancer annually.

Update August 2016:  Autopsy studies do not mirror the increasing incidence of thyroid cancer, again indicating a problem with overdiagnosis (23):

“the observed increasing incidence (of thyroid cancer) is not mirrored by prevalence within autopsy studies and, therefore, is unlikely to reflect a true population-level increase in tumorigenesis. This strongly suggests that the current increasing incidence of iDTC most likely reflects diagnostic detection increasing over time. ” (23) by  L. Furuya-Kanamori,  Prevalence of Differentiated Thyroid Cancer in Autopsy Studies Over Six Decades: A Meta-Analysis. Journal of Clinical Oncology, 2016.

Coping with Active Surveillance


Has your doctor said that active surveillance,also known as watchful waiting, is a treatment option for you? Many people with early forms of prostate cancer, breast cancer, thyroid cancer, lymphoma, and skin cancer are told they should consider this option. But even if you’ve made the choice to go that route, you may still worry about what’s happening in your body. MSK psychiatrist Andrew Roth offers strategies to help you cope.

Highlights
  • Active surveillance can be a welcome alternative to surgery, chemotherapy, and other more aggressive forms of treatment.
  • Some people struggle with the uncertainties and lack of closure with this option, however.
  • Our experts offer advice and support to help you cope.

It’s the dreaded diagnosis: cancer. But instead of surgery, radiation, or another invasive treatment, your doctor recommends that you enroll in a program of active surveillance, also known as watchful waiting.

This can be positive news in many ways. With active surveillance, you have the benefit of not having to go through surgery or experience uncomfortable side effects from medicines or radiation therapy. Instead, you agree to a regular schedule of check-ins, scans, or other tests to make sure your cancer isn’t growing or changing over time.

Cancer sometimes grows very slowly or not at all. As doctors learn to better predict whose tumors will get bigger or spread, they’re increasingly recommending active surveillance for patients with certain early forms of prostate cancer, breast cancer, thyroid cancer, lymphoma, and skin cancer.

“Active surveillance is a great choice for a lot of people,” says Memorial Sloan Kettering psychiatrist Andrew Roth. “But it’s not for everyone.” For some people, just knowing there’s something abnormal going on in their body makes them very anxious. “With active surveillance, there’s a burden in knowing that things aren’t neatly tied up and behind you,” he explains. Even if it’s not likely, “you have to face the possibility of needing more invasive treatment down the road.”

He offers these ways to cope:

Leave the Worry to Your Doctor

We live in an information-saturated world, and it’s easy to question and second-guess a doctor’s advice. Some people travel to different doctors for testing and second opinions, for example. Or they spend hours on the internet reexamining their options.

Dr. Roth recommends that once you find a doctor you trust, try to accept his or her conclusion that active surveillance is the best choice for you. “It’s hard,” he explains, “but if you can, let the doctor worry for you.”

Then, he says, focus on what you can control. For example, ask the doctor to explain how your age, general health, and family background contribute to active surveillance being right for you. He or she can also put into perspective any confusing statistics about treatment choices and outcomes.

“The more the doctor can help you understand why active surveillance is a good choice for you as opposed to other treatment options, the more confident you’ll likely feel,” says Dr. Roth.

Don’t Go It Alone

When dealing with cancer, emotional support is crucial. So when it’s time for your regular surveillance checkup, Dr. Roth recommends asking a friend or family member to come along for companionship and comfort.

This person can also take notes — by keeping track of what the doctor says, you’re less likely to get confused or distort the facts later on. Dr. Roth suggests repeating back what you’ve heard before the appointment ends. “Try saying, ‘So what I hear you telling me is….’” This can help with a reality check later on, if you start to question what the doctor actually said.

Reaching out to other people in active surveillance is also a good idea, he adds. Join a support group. Professional counseling can also help, as can meditation, relaxation, yoga, and other activities, all of which are offered through MSK’s Integrative Medicine Service.

MSK internist Debra Mangino

Consider Lifestyle Changes

“Being in active surveillance is a great opportunity to start taking better care of yourself,” adds Dr. Roth. Make sure you’re eating well and exercising, “without going bananas.” The feel-good endorphins will help you handle stress better. “And while you’re exercising, you’re at least not focusing on cancer or being in active surveillance,” he adds.

Find Distractions

It’s normal to worry a bit, notes Dr. Roth. You may occasionally feel buyer’s remorse. When this happens, he suggests reminding yourself that if there were a more “right” decision, your doctor would have said so at the start. “Don’t miss enjoying life because you’re worried about what might happen down the road!” he adds.

Discover the power in keeping busy. Distract yourself with whatever works for you — crossword puzzles, cooking, listening to music, anything that keeps your mind occupied.

“And then think about what you’ve gained,” he suggests, like freedom from the side effects and other difficulties that can happen with surgery and other more invasive treatments.

Incidental Thyroid Nodules and Thyroid Cancer Considerations Before Determining Management


The worldwide incidence of thyroid cancer is increasing substantially, almost exclusively attributable to small papillary thyroid cancers. Increased use of diagnostic imaging is considered the most likely explanation for this reported rise, but other factors may also be contributing. The increase in health care expenditures related to managing these presumably low-risk cancers, without a clear patient benefit, has resulted in a backlash against the early detection of thyroid cancer. Currently, there is no way to confidently predict which incidentally detected thyroid nodule may be the precursor to a more aggressive process. Predictions such as these would require more accurate characterization of the biology of individual thyroid cancers than is currently possible. With time, we might prove our ability to confidently differentiate low-risk from high-risk thyroid cancers, but until that happens, routine screening for thyroid cancer by imaging billed as a “health checkup” should not be performed. However, incidentally detected thyroid nodules should be reported, and a clear medical team management plan should be developed. Our ethical responsibility is to provide patients with objective, evidence-based information about their disease status, not to assume that we know what is best for them by selectively withholding information. In addition, providing patients with psychosocial assistance will help them process the information necessary to make informed decisions that will provide them with the most value when a small thyroid nodule or cancer is incidentally identified. Herein, we summarize the epidemiological data for disease incidence, discuss some controversies in disease management, and outline the key elements and ethical considerations of informed decision making as they apply to managing incidentally detected thyroid nodules and thyroid cancer.

RAI treatment may increase second primary malignancy risk among children, young adults with thyroid cancer


An elevated risk for second primary malignancy, especially salivary gland cancer, was found among pediatric and young adult patients who received radioactive iodine for differentiated thyroid cancer, according to recent study findings published in Thyroid.

“The use of adjuvant radioactive iodine therapy in patients with thyroid cancer is known to be associated with an escalated risk of second primary malignancies,” the researchers wrote. “This risk has been quantified in several large studies of adult patients. Risks have not been well defined in the pediatric population, due to the relative rarity of this cancer in this population.”

Luc G. T. Morris, MD, MSc, FACS, of Memorial Sloan Kettering Cancer Center in New York, and colleagues evaluated 3,850 pediatric and young adult patients (< 25 years) from the SEER 17 Registry between 1973 and 2008 undergoing treatment with surgery and with or without radioactive iodine (RAI) for differentiated thyroid cancer (DTC) to determine the risk for second primary malignancies attributable to RAI among this population.

Overall, 43.6% of patients received postoperative RAI. The number of patients receiving postoperative RAI increased from 4% in 1973 to 62% in 2008 (P < .001).

Patients treated with RAI developed excess second primary cancers, mostly salivary cancers and smaller numbers of leukemias and renal cancers. No increased risk for second primary malignancy was found among the group not treated with RAI.

“It is critical to carefully weigh the risks and benefits of RAI therapy in young patients,” the researchers wrote. “This is a decision that needs to be considered in light of both patient and tumor characteristics on a case-by-case basis. In young patients with distant metastases or high-volume, extensive nodal mestastases, that are likely to be iodine-avid, the benefits of RAI therapy probably outweigh the risks of [second primary malignancies] we have described. However, in many cases, such as patients with intrathyroidal, node-negative tumors, or patients with low-volume central compartment nodal micromestastases, who have an excellent long-term prognosis and low risk of locoregional recurrence, the risks of developing [second primary malignancies] may outweigh the minimal benefits of RAI therapy.” –by Amber Cox

Do Your Genes Increase Your Risk of Getting Cancer Twice?


If you knew you had an 85 percent lifetime risk of breast cancer — a risk six and a half times higher than for most women — would you be more vigilant?

If you knew your risk of developing a second cancer was eight times higher than most people’s, would you talk to your doctor right away?

These questions are not meant to be scary. They’re the types of questions patients with genetic mutations need to ask. They can save your life.

Our most recent research shows that people with a certain genetic mutation are much more likely to develop cancer a second time. Knowing about such risks helps you, as a patient, make better decisionsabout screening and treatment.

What the study shows

“A second ‘primary’ cancer is completely different. It’s a distinct type of cancer from the first, and it can strike different parts of your body.”

Charis Eng, MD, PhD

Founding Chairwoman of the Genomic Medicine Institute

When I say “second cancer,” I do not mean a recurrence of the same type of cancer. A second “primary” cancer is completely different. It’s a distinct type of cancer from the first, and it can strike different parts of your body.

To study this risk, our research group followed 114 patients with a PTEN gene mutation for seven years. Out of those patients, 40 percent developed a second primary cancer.

The results are stunning. According to our analysis, people with this PTEN mutation are nearly eight times more likely than the general population to develop a second cancer. For women, the risk of a second primary breast cancer is nine times higher. For endometrial cancer, it’s 14 times higher.

For people with inherited cancer genetic mutations, knowing about this increased risk matters, both for treatment and monitoring.

What the results mean for patients

Once a patient knows about a PTEN mutation — or other high-risk mutations — screening and monitoring must become a lifetime habit.

For example, a high-risk woman may need to start MRI screenings and mammograms earlier than the general population. She also needs to continue them indefinitely, remaining vigilant for life.

But better screening isn’t the only important outcome. Women with an especially high risk of breast cancer — both a first and second type — should discuss prophylactic (preventive) mastectomy with a doctor. It’s a hard conversation to have, but when your risk is so high, it’s also worthwhile.

Likewise, we found that men with the PTEN mutation have a much higher risk for a second primary thyroid cancer. That has implications for surgery. Often a surgeon treating thyroid cancer will leave part of the thyroid intact. But for men with such a high risk, the surgeon may want to remove all of the thyroid. Doing so would decrease the man’s chances of developing a second cancer.

We hope other independent researchers will validate our results in their own studies. In addition, future research should explore whether other genetic mutations increase the risk for second primary cancers. This study is just a first step in understanding a little-known risk — and how patients can decrease it.