Tiny thyroid cancers may be over-diagnosed and over-treated. But you still need to see a doctor about signs and symptoms of thyroid cancer.
We’ve all heard the advice, it’s best to find cancer at the earliest possible stage when treatment can usually be most successful. While that’s true in most cases, in recent years researchers have found not all cancers are the same, and some may never spread or threaten health — so treatment may cause more harm than the cancer.
Thyroid cancer is a case in point. The U.S. Preventive Services Task Force has issued a recommendation against thyroid cancer screening in adults — typically done by your doctor feeling your neck or using ultrasound to look for lumps — unless you have symptoms.
The reason, the official statement explains, is due to medical experts’ increasing concerns about over-diagnosis and over-treatment of small asymptomatic malignancies which, if left alone, will likely never harm health.
The rate of thyroid cancer in the U.S. soared by 4.5 percent annually over the past decade. But the task force research, published in JAMA, suggests the spike in thyroid cancer rates was due to over-zealous screening of people with no symptoms, resulting in the discovery of small thyroid cancers that never go on to harm. The report points out autopsy studies have found a third of adults who die from other causes had small thyroid cancers, indicating these tiny malignancies are common and very often have no impact on health.
“It’s becoming widely accepted that physicians are finding and diagnosing more small nodules in the thyroid gland that may never cause a medical problem,” said thyroid cancer researcher Luc G. T. Morris, MD, of Memorial Sloan Kettering Cancer Center, in a National Cancer Institute report. “We would never find these nodules by touch.”
The U.S. government task force concluded “there is moderate or high certainty that screening (for asymptomatic thyroid cancer) has no net benefit, or that the harms of screening outweigh the benefits.” The report points to considerable evidence of potential harm from unnecessary treatment of tiny thyroid cancers. Surgery and radioactive iodine therapy can result in nerve damage, the development of hypoparathyroidism, and salivary gland injury causing chronic dry mouth.
However, it’s important to note the task force recommendation only applies to people with no signs and symptoms of thyroid cancer. If you do have symptoms of thyroid cancer, that’s a different matter — and the government panel of experts recommends being screened for cancer.
The thyroid gland sits at the base of your throat near your windpipe. When functioning properly, it produces hormones to help regulate heart rate, blood pressure, body temperature, and weight.
If you have any of these signs and symptoms of thyroid cancer, the American Cancer Society advises seeing your doctor ASAP:
- A lump in your neck, which may grow quickly
- Swelling in your neck
- Pain in the front of your neck, which may move up toward your ears
- Hoarseness or other voice changes that don’t go away
- Difficulty swallowing
- Feeling you aren’t breathing normally
- A chronic cough not due to a cold
Of course, many conditions other than cancer can cause these symptoms. And the American Cancer Society points out most thyroid lumps are benign. However, don’t delay having your thyroid checked out by your doctor if you do have any symptoms of thyroid cancer.
Even if you have thyroid cancer that needs treatment, the good news is most thyroid malignancies are highly treatable, and cure rates, especially for the most common types of thyroid cancer, are very high, according to the National Cancer Institute.
March 30, 2020
Christopher Nystuen, MD, MBA