The “what you don’t know can hurt you” phrase may run opposite in healthcare. In other words, knowing more is not always better.
Let’s face it, we ALL have something wrong with us. I have always told patients that if they look hard enough, doctors can find something wrong with you. We are seeing mounting evidence that screening for certain conditions are creating monsters out of molehills (I know, I know–it’s supposed to be “mountains,” but mountains don’t increase the cost of healthcare like monsters do).
- Mammography finding ductal carcinoma in situ (DCIS) that the body would resolve on its own, but instead lead to surgery, chemo and radiation treatments.
- PSA testing that identifies non-aggressive tumors and would take decades to progress, and yet prostate surgery, radiation and chemo are used.
- Blood pressure below 160 systolic and 100 diastolic are medicated with beta blockers that increase stroke and diabetes or calcium channel blockers that increase the risk of breast cancer, and yet keeping the blood pressure “under control” has not advantage on heart attacks, strokes or risk of death.
- MRIs and CT scans that frequently don’t match the patients’ symptoms, but lead down a path to injections and surgery.
- The notorious “annual medical exam” that everyone thinks is so important, does nothing for prolonged life but does increase medication usage and the chance of being given a diagnosis.
Now that we’ve dispelled a little of the “more knowledge is better” theory, we can move on to this particular article looking at the diagnosis of thyroid cancer. As a way of background, in the 1980’s ultrasonography of the thyroid became available, followed by guided biopsy in the late 1990’s. This advancement in technology has led to the ability to biopsy smaller and smaller nodules all the way down to 2 mm.
Because of this increase in imaging technology, the incidence of thyroid cancers has increased 322%. 90% of the cancers identified are papillary cancers, which is considered the least dangerous type of the cancers. As a matter of fact, small papillary cancers are a common finding at autopsy.
Here’s the problem, despite the 322% increase in the diagnosis of thyroid cancer, the mortality rate from thyroid cancer has remained unchanged in the 30+ years since 1979. So basically, we are finding more thyroid cancer and treating the cancers more aggressively, but we’re not saving any lives.
What we ARE doing is surgically removing one of the most hard-to-balance endocrine glands in the body, leading to continual challenges throughout the life of the patient. Combine this with the fact that conditions like prediabetes greatly increase the risk of thyroid nodules and cancers, and you’ve got a situation where serious conditions like prediabetes are ignored, but the gland showing the problem (in this case the thyroid) is removed. Two negatives without a positive.
The bottom line is that you should ask whether imaging on your thyroid is absolutely needed in your situation. If any nodules are found, again ask some heard questions about whether anything needs to be done or can you follow a wait-and-see approach.