[ RadSafe ] Re: 'Rise' in thyroid cancers comes from better detection methods

[Emil]

John,

I can not keep up with developments in this field, being busy doing
other exciting things. I heard the number colon cancers are down...

I am wondering, are numbers of other cancers on the "rise" as
thyroid? 
If so could it be for the same reason, better detection effect?

Regards,

Emil.


> 
> Message: 3
> Date: Tue, 20 Jun 2006 09:56:27 -0700 (PDT)
> From: John Jacobus <crispy_bird at yahoo.com>
> Subject: [ RadSafe ] Article: 'Rise' in thyroid cancers comes from
> 	better	detection methods
> To: radsafe <radsafe at radlab.nl>, know_nukes at yahoogroups.com
> Message-ID: <20060620165627.39127.qmail at web54301.mail.yahoo.com>
> Content-Type: text/plain; charset=iso-8859-1
> 
> >From another list server
> http://www.diagnosticimaging.com/showNews.jhtml?articleID=189400746
>  
> Diagnostic Imaging Online
> June 14, 2006 
> 
> 'Rise' in thyroid cancers comes from better detection
> methods
> 
> More sophisticated detection methods account for a
> dramatic increase in thyroid cancer over the last 30
> years, rather than a true change in occurrence of the
> disease, according to a study in the Journal of the
> American Medical Association. Physician self-referral
> may also be a contributing factor. 
> 
> Radiation is a common cause of thyroid cancer, and
> some have questioned whether the increase in thyroid
> cancer incidence was linked to greater exposure to
> radiation in the environment. 
> 
> But stable mortality rates despite the apparent rise
> in incidence led researchers to conclude that the
> increase is actually due to better detection, not
> greater occurrence of disease. 
> 
> Dr. Louise Davies and Dr. H. Gilbert Welch of the VA
> Outcomes Group and Dartmouth Medical Center
> investigated causes behind the increase of thyroid
> cancer incidence from 3.6 per 100,000 in 1973 to 8.7
> per 100,000 in 2002 (JAMA 2006;295:2164-2167). 
> 
> The 2.4-fold increase is mostly due to the detection
> of subclinical papillary cancers 2 cm or smaller.
> During the 30-year span, the incidence of papillary
> cancers grew from 2.7 to 7.7 per 100 000, a 2.9-fold
> increase. 
> 
> The researchers found no significant change in
> incidence of the less common histological types:
> follicular, medullary, and anaplastic. In 2002, for
> example, papillary cancers accounted for 88% of all
> thyroid cancers, while 9% were follicular, and 3% were
> either medullary or anaplastic. 
> 
> "Given the known prevalence of small asymptomatic
> papillary thyroid cancers at autopsy, we believe this
> suggests that increased diagnostic scrutiny has caused
> an apparent increase in incidence of cancer rather
> than a real increase," the authors said. 
> 
> The use of ultrasound for thyroid disease became
> widespread in the 1980s, while fine-needle aspiration
> flourished in the 1990s. Ultrasound can detect nodules
> as small as 0.2 cm. FNA, which can be performed
> quickly during an office visit, replaced lengthy
> nuclear medicine scans. 
> 
> "The ability to detect small nodules and then aspirate
> their contents has clearly facilitated the diagnosis
> of these smaller cancers," the authors said. 
> 
> In fact, overdiagnosis of the disease has itself
> become a concern. While many people may die with
> papillary nodules, they do not die from them. Yet 75%
> of those with papillary cancers less than 1 cm undergo
> total thyroidectomy. This procedure carries small but
> significant risks of complications and requires
> lifetime maintenance and surveillance. 
> 
> This concern is growing as thyroid ultrasound moves
> from the radiology department to physicians' offices.
> When ultrasound is used as an office-based adjunct to
> physical examination, the likelihood of self-referral
> increases, along with the number of nodules -- and,
> ultimately, cancers -- found and treated. 
> 
> The authors suggest that follow-up for symptomatic
> thyroid nodules may be an appropriate course and that
> papillary cancers smaller than 1 cm could be
> classified as a normal finding. 
> 
> They conclude that further research is needed to
> determine appropriate management of small papillary
> cancers detected with ultrasound and fine-needle
> aspiration. Data for the study came from Surveillance
> Epidemiology and End Results (SEER) and the National
> Vital Statistics System. 
> 
> For more information from the Diagnostic Imaging
> archives: 
> 
> Ultrasound helps reveal vascular patterns in thyroid
> cancer
> http://www.dimag.com/showArticle.jhtml?articleID=170704231
> 
> 
> New formula improves parathyroid scintigraphy 
> 
> Whole-body PET/CT proves superior for staging cancers 
> 
> SPECT/CT settles into variety of clinical practice
> settings 
>  
> -- By Emily Hayes 
> 
> © 1996 - 2006 CMP Healthcare Media Group LLC, a United
> Business Media company 
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> +++++++++++++++++++
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> director.
> 
> -- John
> John Jacobus, MS
> Certified Health Physicist
> e-mail:  crispy_bird at yahoo.com
> 




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