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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