The Math/Computer Guys Look at Thyroid Cancer
Don’t ask me how they do the modeling.
- Thyroid cancer affects over ½ million people in the U.S. and the incidence of thyroid cancer has increased worldwide at a rate higher than any other cancer, while survival has remained largely unchanged. The aim of this research was to develop, calibrate and verify a mathematical disease model to simulate the natural history of papillary thyroid cancer.
Herein, we modeled the natural pre-clinical course of both benign and malignant thyroid nodules with biologically relevant health states from normal to detected nodule.
We show the predicted underlying benign and malignant prevalence of nodules in the population, the probability of detection based on size of nodule, and estimates of growth over time in both benign and malignant nodules.
Future model analyses will test and assess various clinical management strategies to improve patient outcomes related to thyroid cancer and optimize resource utilization for patients with thyroid nodules.
Incidental PTC were not age or gender specific, we have learned that some nodules remain clinically insignificant indefinitely . Starting in the early 1990’s, our colleagues (Y.I., A.M.) at Kuma Hospital in Japan began offering active surveillance or surgery for low-risk PTmC. During extended follow-up, no patients died of thyroid cancer and <10% ultimately demonstrated evidence of significant growth of their tumors. In another Japanese cohort, Sugitani et al found similar results. After a mean follow-up of five years, during which time only seven patients were lost to follow-up, 7% of lesions grew, and only 4% eventually underwent surgery. Both Japanese studies found that younger patients’ tumors were more likely to progress, and that rescue surgery was successful. These findings have motivated changes in the most recent American Thyroid Association guidelines to allow for the consideration of active surveillance of low-risk PTmCs
In addition to estimating over diagnosis and treatment,W will provide the foundation to assess which clinical interventions are effective in identifying and treating appropriate patients. After surgery for PTC, 10–28% of patients develop recurrent disease. Simulations of large numbers of patients will allow us to objectively assess if conventional risk-stratification algorithms, use of known and future molecular diagnostics, post-operative adjuvant therapy, and individually tailored-approaches to the frequency and intensity of surveillance for tumor recurrence are cost-effective.
Thank God for these math wizards.
We are lucky to have some math heavy weights working on thyroid problems like UCLA’s Joseph DiStefano III, editor of this journal.