Papillary carcinoma of the thyroid in young people

Cancer is a really bad diagnosis and I hope I never get one. But I was taught a long time ago that if I had to get a cancer, a papillary carcinoma of the thyroid would be a good one to get.

An article in the World Journal of Surgery in June 2010, selected as highly credible by McMaster PLUS, bears that out.

Long-term follow-up really is the best way to learn about many diseases, especially cancer. Ian D. Hay and five co-authors at the Mayo Clinic studied 215 patients who, between the ages of 3 and 20 (median age 16), were treated for papillary carcinoma of the thyroid between 1940 and 2008.

Bottom line: only two patients died from their thyroid cancer. About one-third received postop I-131 thyroid ablation; there was no difference in recurrence rates between those and the patients whose thyroids were not radioactively ablated.

After 30 to 50 years of follow-up, 22 patients had died of any cause, of which 15 succumbed to a different cancer. Of those, 73% had received postoperative therapeutic irradiation for their thyroid cancer.

Large red flags waving.

This is a big retrospective study spanning many decades of experience. Seems like these data call into serious question the effectiveness of the dogma of postop radioactive thyroid ablation.

In addition, it seems to me that one treatment (postop external irradiation) may have been worse for the patient long term than the disease it was supposed to be treating, at least in terms of likelihood of being followed by a new fatal malignancy.

Time to rethink routine care of papillary carcinoma of the thyroid in young people.

Remember Hippocrates as he is said to have said, “First, do no harm.” Don’t expose children and adolescents to radiation unless you have areally  good reason.

George Lundberg is a MedPage Today Editor-at-Large and former editor of the Journal of the American Medical Association.

Originally published in MedPage Today. Visit MedPageToday.com for more cancer news.

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  • anonymous

    Although some types of cancer obviously have a worse prognosis, there’s really no such thing as “a good cancer to get.”

    Even if you achieve complete remission, you will still have long-term thyroid issues. Contrary to popular belief, thyroid hormone levels are not necessarily easy to manage in everyone. And as this study demonstrates, there’s always the risk of second malignancy and other challenges related to the initial cancer treatment.

    Not to mention the fact that it goes on your health history and will follow you for the rest of your life, making it basically impossible for you to get affordable insurance on your own.

    It’s time to retire the phrase “a good cancer to get.” The good cancer to get is… none at all.

  • http://AmericanHealthScare Richard Young, MD

    Yes, but cancer will always be part of the human story.

    This study and others that remind us of the very nonlethal nature of most thyroid cancers needs to penetrate some other specialty silos. The freight-train loads of patients who had CT scans in an ED and were told they had a thyroid mass probably should be left alone. A one-time follow up scan well into the future is all I suspect is justified. Of course there is no evidence to say what the right answer is.

    The NIH has no explicit mandate to conduct research on cost-effective care. A study looking at the long term outcomes of people with thyroid incidentalomas would be great for the comparative effectiveness research program (I don’t know, maybe it already is). A few million dollars invested by the feds on this issue could potentially save hundreds of millions of dollars in unnecessary scans and surgeries for Medicare, Medicaid, and private insurance plans in the future.

    In the big picture, this issue is another example of the habit of the American medical establishement to assume more treatment equals better care. This assumption is correct sometimes, but it is a huge contributor to our over-priced healthcare system.

  • pw

    As a young person who had Pap. Ca of the Thyroid at 22 yrs old (Im now 30), it was definitely no fun, but certainly the treatments are certainly much less taxing than other cancers.

    I had I-131 after my surgery and have always worried what the long term effects of that treatment could be on my long term cancer outlook.

    Aside from breast cancer all the doctors that Ive spoken with say there is no increased risk of developing a second primary cancer JUST because you’ve had thyroid cancer – but maybe as the article highlights the i-131 is playing a role in that…

    Being that I was a stage 1 Ive many times wished I’d forgone the radiation, but in the whirlwind of a cancer diagnoses (cause you don’t know its the “good one” to get initially) you really throw your life and trust in your doctors hands.

    Not to mention even as informed as I became, some things dont come to light till almost a decade later, lol.

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