Thyroid Cancer 101: 9 steps to Avoid Bankruptcy on your way to a Thyroid Cancer Diagnosis
Thyroid Cancer patients are “almost three times more likely to declare bankruptcy,”
500,000 thyroid cancer survivors are subjected to more tests more imaging and worse more surgery.
One key problem is that care remains fragmented with complicated treatments and patients sometimes getting wrong or unnecessary treatments.
That fact remains that thyroid cancer is expensive from the start, with diagnoses traditionally involving Ultrasound, 3D Imaging, FNA molecular testing, radiation therapy and surgical biopsies and procedures.One hopeful bright spot was the possible use of “liquid biopsies for fragments of thyroid cancer DNA in a simple blood sample.
However, my recent unpublished study found “liquid biopsies” were not helpful for the slow growing well differentiated thyroid cancers.
ThryoSeq, ThyGenX, Afirma and Rosetta, molecular marker tests on needle biopsy specimens stands to prevent overtreatment of more than 90 percent of those diagnosed with the cancer. Only 8 percent of patients, as it turns out, require full removal of the thyroid. These marker tests provid great relief for most patients and significant cost savings.
What can you do as a patient to decrease your odds that you will go bankrupt if you get thyroid cancers.It starts with simple things.
- Refuse any “screening” ultrasound of your thyroid without a clear indication. Too many very small nodule are found, biopsied, and sent to surgery.
- If a small nodule is found don’t rush for a biopsy as this cancer is not like fast growing breast or lung cancer.You have time to get opinions if a biopsy is even needed. Most are harmless and can be observed and only biopsied if they show growth to > 1.5 cm.
- If you agreed to a biopsy then get to an expert in endocrine neck ultrasound and have an USGFNA with collection of molecular markers. Avoid any radiology biopsy if they don’t collect markers or don’t have access to micro-dissection of the slides for markers post biopsy.
- Don’t have surgery without expert review of the cytology. Over-diagnosis of suspicious results by pathologists is not your friend as it leads too many unnecessary thyroid surgery.
- Don’t fall the “John Wayne” method of surgeons. Getting the thyroid out is not the answer in many cases as it is the cause of lifetime thyroid treatment and unnecessary complications of voice change and low calcium disease for the rest of your life.
- If there is a diagnosis of thyroid cancer stop and get outside opinions. There are some tumors that look like cancer and were called cancer until 2 years ago, but are now called a benign follicular tumor with look alike papillary cells. NIFT-P. If this is a possible diagnosis you will be saved from a total thyroidectomy as the nodule needs to be looked for invasion and if it is NIFT-P you are done. This not cancer and you don’t need thyroid cancer follow up and it is not on your insurance for the rest of your life. You may not need thyroid hormone replacement therapy or radioiodine or costly cancer follow up examinations.
- If you truly have a classic papillary thyroid cancer and it is small <1.5 cm because you did not follow rule number 1 and refuse a screening ultrasound. You still may avoid unnecessary costly surgery by having this small harmless cancer followed instead of immediate surgery. A program called active surveillance can follow the micro-cancer and if it grows slightly by 3 mm a surgery is indicated.However only a small number ever have late surgery.
- If you are nervous at having a harmless cancer in your neck for years, there is two options. Mayo clinic’s Ian Hay has used Ethanol ablation PEI and DR.JH Baek in Korea does radiofrequency ablation RFA. Both have been shown to ablate the micro-cancer inside your thyroid. You will not need surgery,and avoid radioiodine and best of all you wont need replacement thyroid hormone for life.
- Last, if you need a total thyroidectomy, and or modified radical neck dissection please have a pre-op neck ultrasound and if suspicious lymph nodes are found an FNA with needle washout thyroglobulin. Positive biopsy will change your surgery to include the neck dissection saving you from a possible second surgery in a few years. Get yourself to a high volume thyroid surgeon doing >25 totals a year to save yourself from the high rate of complications from low volume surgeons doing fewer cases a year.Good Luck and always opt for more evaluation by experts during any of these 9 steps to avoid unnecessary surgery and possible over-treatment and bankruptcy.I am available through my thyroid center for referrals to Korea or Italy for alternative therapy for micro-papillary cancers.Call Matt at 310-393-8860 for ethanol ablation in my center as well.. Richard Guttler MD,FACE,ECNU www.thyroid.com