Here’s something that may surprise you: not every cancer needs to be treated. Most people’s first reaction when they hear the word cancer is: “Get it out. Now!”
Understandable, but some cancers are so slow-growing — what doctors call indolent — you may be better off leaving them alone. I’m going to focus on thyroid cancer. For years, thyroid cancer was the fastest-rising cancer diagnosis in the United States. Today, each year roughly 45,000 Americans are diagnosed with it, up from 37,000 a decade ago.
You’d think there’s an epidemic. But let’s bring in some Health Your Self skepticism here, and to similar situations.
There isn’t an epidemic. What we have are better diagnostic tools that can pick up tiny thyroid cancers, and they are usually discovered incidentally — meaning doctors spot them while scanning for something else.
The problem is that finding minute thyroid tumors has fueled an epidemic, yes, but of overdiagnosis and subsequent overtreatment.
The thyroid is important: it regulates the body’s metabolism, affecting everything from heart rate and energy levels to sleep.
And for years, slow-growing thyroid tumors were removed — along with either one lobe of the thyroid or the entire gland.
But the American Thyroid Association has guidance for small tumors: if the cancer is under about one centimeter — roughly the size of a pea — doctors can offer what’s called active surveillance, where a patient is monitored periodically to make sure the lump hasn’t grown. Even with these guidelines, as many as 40% of people diagnosed with thyroid cancer go under the knife.
And that’s what’s important to focus on here.
Once the word cancer enters the conversation, the momentum toward surgery can be hard to stop, given patients’ fears and surgeons' entrenched ways.
Surgeons operate for a living; it’s how they make their money. Faced with a scared patient, the answer easily becomes “why not?” There’s also what I call the referral loop. When a primary care doctor finds a small tumor and thinks, rightly or wrongly, that it should come out, he talks to the surgeon he usually calls, who, even subconsciously, goes along, afraid of upsetting that precious referral pipeline.
What are the lessons here? Keep your wits about you, even in the face of a scary diagnosis. For example, if surgery for any indolent cancer, including prostate, is optional, and always ask, look up the downsides.
For thyroid cancer, patients who have surgery can be left with voice changes, calcium deficiency, and, if the entire thyroid gland is removed, the need for lifetime thyroid hormone medication, which itself may have side effects such as anxiety or fatigue, until the correct dose is worked out.
If you go ahead with surgery, use a doctor who specializes in thyroids, not a general surgeon, and preferably one who performs at least 25 thyroid surgeries a year.
One final thought about active surveillance for indolent cancers: if you find it inconvenient, consider this — even after surgery, patients still need monitoring for years — and sometimes for life.
Janice M. Horowitz covered health for Time magazine for more than two decades; she created and hosted the public radio segment, Dueling Docs: The Cure to Contradictory Medicine.
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