Abstract
BackgroundIt is estimated that one of the potential cause of the increasing prevalence of thyroid cancer (TC) is the easier and widespread access to diagnostic tools. If an individual evaluates the thyroid gland due to a mentioned mechanism without considering TC risk factors or symptoms, we can describe this phenomenon as cancer screening activity (CSA).Aim of the studyWe 1) estimated what types of TC were diagnosed due to CSA, 2) analyzed what clinicopathological features were characteristic of TCs diagnosed by CSA, 3) determined if these features were characteristic of indolent cases, and finally we 4) assessed whether CSA could have resulted in the increasing incidence of potentially indolent papillary thyroid cancer (PTC).Materials and methodsA retrospective review of 4,701 medical records of patients admitted and surgically treated at one surgical center between 2008 and 2017 was performed. Among the enrolled patients, 569 (12.1%) had thyroid malignancy, and 514 (10.9%) were diagnosed with PTC. We divided these patients into two groups: 1) patients in whom TC diagnostics were performed without considering any TC risk factors or symptoms (CSA-yes) and 2) those in whom TC was diagnosed due to TC risk factors or symptoms (CSA-no). We then compared the clinicopathological features of these two groups.ResultsThe most common type of TC diagnosed in the CSA-group was PTC (p = 0.024). CSA-yes patients showed a significantly lower degree of Tumor-Node-Metastasis (TNM) staging and demonstrated a significantly lower rate of multifocality, but not of bilaterality (p<0.0001 and p = 0.198, respectively). In the CSA-yes group, the number of TC foci was significantly lower than that in the CSA-no group (p<0.0001). All clinicopathological features characteristic of aggressive cases of TC were absent in CSA-yes patients (p<0.0001), while all features observed in CSA-yes patients were characteristic of indolent cases (p<0.0001).ConclusionsThe use of CSA results in the diagnosis of indolent cases of PTC and may be one of the potential causes of overdiagnosis and overtreatment of this malignancy.
Highlights
In managing papillary thyroid cancer (PTC), there exists a basic question: where is the border between evidence-based surgical management and overtreatment [1] this dilemma is emphasized due to potential complications, which may appear after the surgical procedure [2]
The most common type of TC diagnosed in the cancer screening activity (CSA)-group was PTC (p = 0.024)
All clinicopathological features characteristic of aggressive cases of TC were absent in CSA-yes patients (p
Summary
In managing papillary thyroid cancer (PTC), there exists a basic question: where is the border between evidence-based surgical management and overtreatment [1] this dilemma is emphasized due to potential complications, which may appear after the surgical procedure [2]. In the case of this specific malignancy, overdiagnosis and overtreatment are observed when the tumor is potentially diagnosed and treated correctly but may result in an unfavorable balance between benefits and adverse events [3, 4]. Based on previous experience with other neoplasms in which a screening program was introduced, a rapidly increasing rate of their prevalence without a concomitant increase in their mortality is observed [6]. Such a situation exists in the case of a prostate cancer screening program [6]; does PTC suffer from the same issue?. If an individual evaluates the thyroid gland due to a mentioned mechanism without considering TC risk factors or symptoms, we can describe this phenomenon as cancer screening activity (CSA)
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