The diagnosis of thyroid cancer has been growing markedly, with a three-fold increase over the last three decades. Almost all of that increase is the result of the detection of such small, localized tumors, that are not normally apparent by palpation but that can be observed with sophisticated imaging techniques.
Davies and Welch reported in the journal Archives of Otolaryngology--Head & Neck Surgery that, after six years of follow-up, 141 of the treated patients, less than half a percent, had died, compared to six of the untreated patients, or 1.4%. They projected that the 20-year survival rate for treated patients would be 99%, while that for untreated patients would be 97%. They concluded that "papillary thyroid cancers of any size that are confined to the thyroid gland have no lymph node metastases at presentation and do not [reach beyond the thyroid gland] are unlikely to result in death due to the cancer." That increase in deaths, they said, is offset by the increased risk of side effects from cancer surgery, which can include permanently low levels of thyroid hormones and significant damage to laryngeal function.
In an editorial accompanying the report, however, Dr. Erich M. Sturgis and Dr. Steven I. Sherman of the University of Texas M.D. Anderson Cancer Center said, in effect, "Hold on just a moment!" While 2 percentage points is a very small difference, they agreed, when extrapolated to the 35,000 patients diagnosed with thyroid cancer each year, that could mean an extra 500 to 700 deaths. "Certainly, most of those hypothetical 500 to 700 people would have wished their physicians had offered them the treatment that had 'statistically' better survival." Some people can be simply observed, they said, but they have to be very carefully selected.
-- Thomas H. Maugh II