What is thyroid cancer overdiagnosis?
Overdiagnosis happens when you get a diagnosis that ends up causing you more harm than good. It can happen for example when a healthy person is diagnosed with a disease, but that disease would never have developed to cause any symptoms. While it may come as a surprise, some cancers are so slow-growing they will never cause a person any harm, if they are left undetected. One example is cancer of the thyroid, the small gland in your neck. Some thyroid cancers grow and cause harm if they are not treated. However, there are other forms of thyroid cancer, including a common type called papillary thyroid cancer, where many of the tumours are so small and so slow-growing they may never cause any symptoms or do harm. It is not yet certain how often this problem of overdiagnosis happens in thyroid cancer, but it is clear some people are being diagnosed with these tiny thyroid cancers unnecessarily.
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What causes thyroid cancer overdiagnosis?
As we try more and more to pick up the early signs of disease, and as technology can see ever-smaller potential “abnormalities” in our bodies, we are diagnosing and treating some things that would never have gone on to cause us any harm, if they were left alone. With thyroid cancer, small tumours are being discovered incidentally in people who don’t have any symptoms of thyroid cancer, but who were being tested for some other reason, usually with a CT scan, an ultrasound, an MRI or x-ray.
In many countries, including Australia, there have been big increases in the numbers of people being diagnosed with thyroid cancer in recent years, with no change in the number of people experiencing bad outcomes or death from their thyroid cancer. Researchers conclude that some of those people have been overdiagnosed.
What harm comes from thyroid cancer overdiagnosis?
The main harm caused by thyroid cancer overdiagnosis is overtreatment, which happens when you get a treatment that won’t help you. The most common treatment for people who receive a diagnosis of thyroid cancer is surgery to remove all or part of the thyroid gland. As a result of that surgery, it’s common that you have to take life-long medication, and in rare cases there are complications of surgery, including damage to your voice. Other harms of overdiagnosis and overtreatment of thyroid cancer may include emotional distress, increased anxiety, depression, insurance difficulties and unneeded financial costs.
What can we do to avoid thyroid cancer overdiagnosis?
Doctors, other health professionals, researchers, consumers and other concerned individuals are working together to try to learn more about this challenging problem of overdiagnosis, including thyroid cancer overdiagnosis, and how to prevent it. Part of the challenge with thyroid cancer overdiagnosis is trying to work out which cancers will go on to cause you harm, and which won’t.
One way to reduce overdiagnosis is to decrease the testing of people who don’t have any symptoms, to try to reduce the numbers diagnosed with the very small thyroid cancers that are highly unlikely to ever grow or cause harm. One way to reduce overtreatment may be to offer those who have been diagnosed with a small tumour the choice between the option of surgery straight away, or the option of actively watching it, and only provide treatment later, if or when it becomes necessary. For the moment, one thing we can all do is be more aware of the danger of overdiagnosis and ask questions – for ourselves and our loved ones – about whether a diagnosis is really needed.