The Hopu Ark team compiled | According to the China Cancer Registry, thyroid cancer in China will continue to grow at a rate of 20% per year. For thyroid cancer, many people think that the diagnosis requires surgical removal, but as the legendary "lazy cancer" and "good cancer", some thyroid cancers grow slowly, even if untreated, it will not affect people's lives. So, how can you tell if thyroid cancer requires surgery? Is the growing amount of thyroid cancer the result of overtreatment?
▲ Image source: healio
Overtreatment of thyroid cancer has become a global problem
Recently, a blockbuster analysis published in The Lancet Diabetes & Endocrinology, based on the GLOBOCAN database, provided an in-depth analysis of age-standardized incidence and mortality of thyroid cancer in 185 countries or regions in 2020.
▲Image source: Reference source[1]
The study pointed out that there are significant differences in the incidence of thyroid cancer in different countries and regions around the world (for example, the incidence of thyroid cancer in women can vary by 15 times), but the mortality rate of thyroid cancer patients remains low, and the mortality data of different countries and regions are similar. That said, overtreatment of thyroid cancer does exist.
In addition, Professor Sugitani, Director of The Department of Endocrinology, Affiliated Hospital of Japan Medical University, pointed out in a lecture that from 1973 to 2002, the number of thyroid cancer patients in Japan increased by nearly 3 times, and the increase in thyroid cancer patients was mostly 1 cm and 2 cm papillary cancer. However, the mortality rate is basically flat, and there is little change, which can be considered as an overdiagnosis of thyroid cancer.
▲ Changes in the incidence and mortality of thyroid cancer, Source: Professor Sugitani Lecture
Most patients diagnosed with thyroid cancer undergo total thyroidectomy and radiation therapy, neck lymph node dissection, and other treatments. Although thyroid cancer surgery is indeed effective, it may also bring serious complications, such as damage to nerves that control the vocal cords, or damage to glands that control blood calcium, resulting in difficulty in making sounds and discomfort in swallowing; some patients may experience persistent fatigue or anxiety, anxiety and other adverse psychology. In addition, patients who have removed the thyroid gland need to take hormones for life to maintain body function, and long-term use of hormones may cause cardiovascular disease (atrial fibrillation and arrhythmias), osteoporosis and other problems.
How to avoid over-diagnosis and treatment of thyroid cancer?
Thyroid papillary carcinoma can be divided into low risk and high risk two categories, of which low risk papillary carcinoma accounts for the vast majority, good prognosis, some patients will not even be affected by papillary carcinoma for life, related survey results show that about 10% to 36% of the population in other diseases after death before detecting thyroid cancer.
In order to avoid the over-diagnosis and treatment of thyroid cancer, Japan has pioneered the "preservation treatment" of thyroid cancer, also known as the "treatment of thyroid cancer based on risk", for low-risk papillary cancer, according to the size of the thyroid tumor, pathological typing, whether lymph node metastasis, the age of the patient and other comprehensive judgment of whether surgery is needed, even if surgery is taken, the surgical method of preserving the thyroid gland (leaf resection) will be selected as much as possible.
Previously, Professor Sugitani, minister of endocrinology surgery at the Affiliated Hospital of Japan Medical University, mentioned in a lecture in China that Japan believes that screening for micropammymal carcinoma is meaningless, so screening is not recommended, and thyroid cancers under 5mm are not recommended for puncture biopsy, but follow-up observation.
In addition, the 2018 edition of the Thyroid Tumor Diagnosis and Treatment Guidelines of the Japanese Society of Thyroid Surgery has divided thyroid papillary carcinoma into four categories: ultra-low risk, low risk, medium risk and high risk, and formulated corresponding treatment strategies.
▲ Grading of the 2018 edition of the Thyroid Tumor Diagnosis and Treatment Guidelines, Source: Professor Sugitani's Lecture
The mainland is a large country with a high incidence of thyroid diseases, and through advanced and scientific diagnosis and treatment, thyroid cancer patients can avoid excessive treatment such as "one-size-fits-all"; avoid the wrong time for diagnosis and treatment, so as to obtain a higher survival rate and a better quality of life.
Therefore, for patients who have detected thyroid nodules and thyroid cancer, it is particularly important to obtain advanced and scientific diagnosis and treatment programs, and Hopu Ark has a deep cooperative relationship with Professor Sugitani, Director of Endocrinology Surgery of the Affiliated Hospital of Japan Medical University, japan, and can formulate the most reasonable treatment plan according to the patient's condition. Friends in need can contact Xiaobian through private message.
References:
[1] The epidemiological landscape of thyroid cancer worldwide: GLOBOCAN estimates for incidence and mortality rates in 2020 - The Lancet Diabetes & Endocrinology
https://www.thelancet.com/journals/landia/article/PIIS2213-8587(22)00035-3/fulltext
National Health Commission of China. Thyroid Cancer Diagnosis and Treatment Specifications (2018 Edition)
[3] China Cancer Registry Center