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Removing ‘cancer’ label from low-risk thyroid tumors may address overdiagnosis, overtreatment
ORLANDO, Fla. — Clinical journals have reported recently on the possible overdiagnosis and overtreatment of low-risk thyroid cancers, particularly papillary thyroid carcinoma. During a session convened at the Endocrine Society Annual Meeting, experts presented perspectives on the possible effects of assigning at least some of these cases a noncancer designation.“This has been really popularized — when a cancer is diagnosed that would otherwise not go on to cause symptoms or death,” Anna M. Sawka, MD, PhD, FRCPC, associate professor, department of medicine, division of endocrinology, Toronto General Hospital, University Health Network, said during the presentation. “What we’re interested in here with overdiagnosis are the very sloping, progressively slow-growing cancers in patients who are unlikely to die of their disease or become symptomatic.”
Implications of name change
Findings published in JAMA Oncology in 2016 suggested that noninvasive papillary thyroid carcinoma be reclassified as noninvasive follicular thyroid neoplasm with papillary-like nuclear features, or NIFTP, to redefine the disease and remove the cancer label.
According to study background, a body of evidence suggests that the encapsulated follicular variant of papillary thyroid cancer (EFVPTC) is mostly indolent, although patients with the condition are currently treated as having conventional thyroid cancer.
One of the study researchers, Yuri E. Nikiforov, MD, PhD, vice chair for molecular pathology and director of the division of molecular and genomic pathology at the University of Pittsburgh Medical Center, said during his presentation that diagnostic criteria for NIFTP include encapsulation or clear demarcation, follicular growth pattern nuclear features of PTC without invasion, and no aggressive histology.
In the study, Nikiforov and colleagues evaluated 109 adults with noninvasive EFVPTC (mean follow-up, 14.4 years) and 101 adults with invasive EFVPTC (mean follow-up, 5.6 years) to determine the frequency of adverse outcomes and recurrence.
“What this paper did was subcategorize these two and said that nonencapsulated or infiltrative [disease] is more like the classical PTC, whereas the encapsulated type is more like follicular adenoma or follicular carcinoma,” session moderator Bryan Haugen, MD, an investigator at the University of Colorado Cancer Center and head of the division of endocrine, metabolism and diabetes at the University of Colorado School of Medicine, said during the presentation.
At the end of follow-up, all patients with noninvasive EFVPTC remained alive without evidence of disease, and none received radioactive iodine ablation. An adverse event was experienced by 12 patients with invasive EFVPTC, including two deaths.
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