{"id":27486,"date":"2021-09-28T12:00:00","date_gmt":"2021-09-28T12:00:00","guid":{"rendered":"https:\/\/www.cancer.gov\/news-events\/cancer-currents-blog\/2021\/thyroid-cancer-diagnosed-more-in-women"},"modified":"2024-11-03T15:14:28","modified_gmt":"2024-11-03T15:14:28","slug":"why-have-thyroid-cancer-diagnoses-spiked-for-us-women","status":"publish","type":"post","link":"https:\/\/ogkologos.com\/en\/why-have-thyroid-cancer-diagnoses-spiked-for-us-women\/","title":{"rendered":"Why Have Thyroid Cancer Diagnoses Spiked for US Women?"},"content":{"rendered":"

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Since the 1990s, a boom in the use of thyroid ultrasound has led to thyroid cancer diagnoses more than tripling.<\/p>\n

Credit: iStock<\/p>\n<\/div>\n<\/figcaption><\/figure>\n<\/div>\n

Thyroid cancer is diagnosed more often in women than men. And over the past few decades, this sex-based gap has grown\u2014substantially.<\/p>\n

A new study, however, indicates that this disparity isn\u2019t what it seems on the surface. A large contributor appears to be that women are more likely to be diagnosed with small thyroid cancers that would have been unlikely to cause problems during their lifetime<\/a>, researchers reported August 30 in JAMA Internal Medicine<\/em>.<\/p>\n

Women were more than four times as likely as men to be diagnosed with a small papillary thyroid cancer<\/a> during their lives, the study found. Such cancers are rarely fatal. In contrast, diagnoses of aggressive and often deadly types of thyroid cancer were nearly equal in men and women. There was also no real difference between sexes in small papillary thyroid cancers found on autopsy, which weren\u2019t detected during life.<\/p>\n

The study wasn\u2019t designed to pinpoint the cause of this imbalance. But women are more likely than men to undergo tests for other medical reasons that can detect these small cancers that otherwise would have probably not been found. \u201cAnd as clinicians, we\u2019re primed to think about thyroid problems more often in women,\u201d said Louise Davies, M.D., M.S., of the Department of Veterans Affairs, who led the new research.<\/p>\n

Currently, it\u2019s not possible to know, on detection, whether any one small thyroid cancer will go on to grow and become a problem, Dr. Davies added. But the large differences by sex in the number of these cancers found during life versus after death indicate that many thyroid cancers found in women would very likely never have caused any problems.<\/p>\n

\u201cWe\u2019re finding [many] cancers that might never progress,\u201d Dr. Davies said. This means that, for many women, treating a thyroid cancer found in the absence of symptoms can have more harms than benefits.<\/p>\n

Because thyroid cancer is often diagnosed in younger women, side effects from treatment can potentially affect their lives for decades, explained Megan Haymart, M.D., an endocrinologist and thyroid cancer specialist at the University of Michigan, who was not involved in the study.<\/p>\n

\u201cIt\u2019s the most common cancer detected in adolescents and young adults aged 16 to 33,\u201d she said. \u201cThere\u2019s definitely a risk for harms to these women.\u201d<\/p>\n

The Potential Downside of Finding More Thyroid Cancers<\/h2>\n

Like other cancers, thyroid cancer isn\u2019t one disease. There are several different types of thyroid cancer (based in part on the type of cell in the thyroid that the cancer began in), and each type can have very different prognoses. For example, few people with anaplastic thyroid cancer<\/a>, a very rare but aggressive type, will live for even a year. But almost everyone diagnosed with a small papillary thyroid cancer will be alive 5 years after diagnosis.<\/p>\n

In fact, past autopsy studies have shown that many people die with\u2014not from\u2014a small papillary thyroid cancer.<\/p>\n

\u201cYou can die with [such] a cancer never knowing you had it,\u201d Dr. Davies said. If these cancers are found by chance, any intervention can potentially be overtreatment<\/a>\u2014that is, therapy for a cancer that would have stayed the same or sometimes even gotten smaller, and never caused any symptoms.<\/p>\n

And overtreatment not only carries the risk of side effects without any benefit to the patient, but it can also include substantial financial costs.<\/p>\n

The most common side effect from surgery to remove part or all of the thyroid gland (thyroidectomy<\/a>) is a lifelong need for thyroid hormone replacement therapy, which can have its own side effects. \u201cMost people feel fine, but some might not feel as well as they did before surgery,\u201d Dr. Haymart said.<\/p>\n

Surgery to remove thyroid cancer also has the potential to damage vocal cord functions or nearby glands that control calcium levels in the body, she explained.<\/p>\n

Since the 1990s, a boom in the use of thyroid ultrasound and needle biopsies, which had been developed in the previous decades, has led to thyroid cancer diagnoses more than tripling. However, during the same period, the proportion of people who have died from the disease remained about the same.<\/p>\n

To get a fuller picture of the differences in thyroid cancer diagnoses by sex, Dr. Davies and her colleagues looked at the incidence of and deaths from all types of thyroid cancer recorded in NCI\u2019s Surveillance, Epidemiology, and End Results Program (SEER)<\/a> database between 1975 and 2017.<\/p>\n

They also searched for all previously published studies that reported the prevalence<\/a> of undiagnosed thyroid cancers found on autopsy for both women and men. Such studies provide an estimate of the proportion of people who die with\u2014not from\u2014thyroid cancer.<\/p>\n

Trends in Thyroid Cancer Diagnosis by Sex and Cancer Type<\/h2>\n

As seen in previous studies, the researchers found that diagnoses of thyroid cancer increased sharply beginning in the 1990s. At the peak of this trend, in 2013, about 22 cases of thyroid cancer were diagnosed per 100,000 women, compared with only about 8 per 100,000 men. Papillary thyroid cancer accounted for around 75%\u201380% of cases diagnosed between 1975 and 1989. This increased to 90% between 2010 and 2017.<\/p>\n

Correspondingly, between 1983 and 2017, women were more than four times as likely as men to receive a diagnosis of a small, localized papillary thyroid tumor. When larger and more advanced papillary thyroid cancers were included, women were only about 2.5 times as likely as men to receive such a diagnosis.<\/p>\n

For more deadly types of thyroid cancer, such as medullary thyroid cancer<\/a> and anaplastic thyroid cancer, the gap between sexes nearly disappeared, with diagnoses being about equally likely for men and women. And from 1992 to 2017, the overall annual death rate from any thyroid cancer diagnosed during life was approximately the same for women and men.<\/p>\n

The researchers also identified eight studies\u2014including more than 23,000 people in total\u2014that reported the prevalence of undiagnosed thyroid cancer on autopsy. Unlike diagnoses made in the living, the prevalence of undiagnosed small papillary thyroid cancer did not differ substantially between women and men.<\/p>\n

Rao Divi, Ph.D., of NCI\u2019s Division of Cancer Control and Population Sciences<\/a>, called the imbalance between sexes reported in the study \u201cstriking.\u201d The findings, Dr. Divi continued, do raise important concerns about overdiagnosis.<\/p>\n

In addition to highlighting the potential for overdiagnosis and overtreatment, Dr. Davies said, these results point to two sides of another problem.<\/p>\n

On one hand, doctors are less likely to think of thyroid cancer as a potential cause of symptoms reported by a man, which can lead to delayed diagnosis for them. On the other, \u201cwe do women a disservice if we say: Women only get the low-risk cancers. That\u2019s not true either,\u201d she said.<\/p>\n

What Happens after a Thyroid Cancer Diagnosis?<\/h2>\n

The disparity by sex in the prevalence of small papillary thyroid cancers found during life and after death suggests that many women are receiving treatment for small tumors that might never have caused symptoms, Dr. Davies explained.<\/p>\n

The factors that lead more women to get a diagnosis of small papillary thyroid cancer are numerous and complex, she said. Women tend to be more likely than men to seek medical care overall. They\u2019re more likely to encounter health issues that may have hormonal causes, such as difficulties with pregnancy.<\/p>\n

Thyroid ultrasound is widely used to evaluate medical problems that may involve the thyroid. But it\u2019s not intended to be used to screen people who don\u2019t have symptoms for thyroid cancer, Dr. Davies explained. However, she added, it often gets ordered along with other tests to speed the process of diagnosing a potential thyroid issue.<\/p>\n

\u201cThat can lead to finding things that were unrelated to someone\u2019s symptoms. And that can also distract from discovering the real cause of the problem someone came to the clinic for,\u201d said Dr. Davies.<\/p>\n

The biggest challenge, said Dr. Haymart, is that it\u2019s currently impossible to predict which tumors found by chance will pose a threat to health.<\/p>\n

\u201cHow do you determine which cancers might be indolent<\/a> and just sit there for the rest of the patient\u2019s life, and which ones might be aggressive and potentially cause harm?\u201d she asked. \u201cThat\u2019s very difficult to tease out.\u201d<\/p>\n

No matter how a small asymptomatic thyroid cancer is found, it can\u2019t be dismissed outright, Dr. Haymart explained. But unlike with many other cancer types, people diagnosed with a small papillary thyroid tumor have time to understand their treatment options and get a second opinion, she added.<\/p>\n

\u201cWith thyroid cancer, typically, making decisions about treatment isn\u2019t urgent,\u201d said Dr. Haymart. \u201cIt\u2019s perfectly fine for people to take time to process the information, think about their preferences, talk with family members and loved ones, and come up with a decision that\u2019s right for them, she said.<\/p>\n

\u201cThere\u2019s time to actually think through these things,\u201d agreed Dr. Davies. \u201cIt\u2019s not an emergency.\u201d<\/p>\n

Some people may be able choose a surveillance approach<\/a>, having a small thyroid nodule imaged regularly and not taking action unless it starts to grow, explained Dr. Haymart. Others may want to have a needle biopsy and make decisions based on those results.<\/p>\n

And molecular tests are becoming available that can help determine whether a small thyroid mass is more or less likely to contain cancer<\/a>. Such tests can help determine whether surgery is needed.<\/p>\n

\u201cMolecular testing has led to improvements, but I think there\u2019s more room for tailored care,\u201d said Dr. Haymart. \u201cWe need additional data on how to incorporate patient characteristics, tumor characteristics, and molecular results [into treatment decision making].\u201d<\/p>\n

More research is also needed to better understand whether thyroid cancer is really a different disease in women and men, she added.<\/p>\n

\u201cAlthough overdiagnosis likely plays an important role, thyroid nodules and thyroid diseases are more common in women in general. So some wonder if there may also be biological differences as well.\u201d<\/p>\n

Source<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

September 28, 2021, by NCI Staff Since the 1990s, a boom in the use of thyroid ultrasound has led to thyroid cancer diagnoses more than tripling. Credit: iStock Thyroid cancer is diagnosed more often in women than men. And over the past few decades, this sex-based gap has grown\u2014substantially. A new study, however, indicates that […]<\/p>\n","protected":false},"author":2,"featured_media":27487,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"footnotes":""},"categories":[5137],"tags":[],"class_list":["post-27486","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-world-news"],"_links":{"self":[{"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/posts\/27486","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/comments?post=27486"}],"version-history":[{"count":1,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/posts\/27486\/revisions"}],"predecessor-version":[{"id":43594,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/posts\/27486\/revisions\/43594"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/media\/27487"}],"wp:attachment":[{"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/media?parent=27486"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/categories?post=27486"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/tags?post=27486"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}