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Clinical Question
Is patient age associated with the progression of low-risk papillary thyroid cancer?
Bottom line
Although the identification of thyroid cancer has skyrocketed over the past 10 years, the likelihood of people dying due to the disease has remained remarkably steady. The verdict? Overdiagnosis. This study found low rates of size progression (0 - 10%). Patients aged 40 years to 50 years were half as likely as younger patients to have tumor diameter growth of at least 3 mm over the 2 to 10 years of follow-up. 1a
Reference
Study design: Meta-analysis (other)
Funding: Other
Setting: Various (meta-analysis)
Synopsis
This meta-analysis began with a search of 8 databases to identify clinical trails, cohort studies, or cross-sectional studies that followed patients with low-risk papillary thyroid carcinoma. The authors identified 5 studies enrolling a total of 2468 patients, mostly women, that analyzed the rate of growth of thyroid microcarcinomas or tumors up to 2 cm in diameter without treatment. Across the studies, 10% or fewer people had tumor growth of at least 3 mm over the 2 years to 10 years of follow-up. Patients aged 40 years to 50 years were half as likely as younger patients to have tumor progression of at least 3 mm (adjusted risk ratio 0.51). There was no significant heterogeneity among the studies.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
Removing the Thyroid From Images, Not From Patients
Commentary on overdiagnosis of low-risk thyroid cancer: https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/…
No
No
Overdiagnosis
Overaggressive thyroid imaging and biopsies of small thyroid (<1 cm) nodules fuel overdiagnosis and should be discouraged by compleling evidence . Even if pathology interpreation of papillary carcinoma is correct, vast majority of them are sublicnical and never life threatening.
good information
Good reminder
reassessment times
I suspect my ENT consultant would increase the time intervals on older patients.