High-tech imaging behind overkill surgery, Mayo Clinic says

High-tech imaging behind overkill surgery, Mayo Clinic says

High tech imaging has led to unnecessary, costly and risky treatment of low-risk cancers, according to a Mayo Clinic study published in the most recent issue of the British Medical Journal.

Researchers examined use of various imaging techniques, finding that their use has spurred a surge in surgical thyroid removal in cases that may have been better left alone. Surgical thyroid removals have tripled in the U.S. in the past 30 years, from 3.6 per 100,000 people in 1973 to 11.6 per 100,000 people in 2009, but the mortality rate of the disease remains unchanged, the study authors noted.

"High tech imaging technologies such as ultrasound, CT and MRI can detect very small thyroid nodules, many of which are slow growing papillary thyroid cancers,” lead author Juan Pablo Brito,an endocrine fellow and health care delivery scholar at Mayo Clinic, said in a press statement. "This is exposing patients to unnecessary and harmful treatments that are inconsistent with their prognosis."

Surgical removal of all or part of the thyroid gland is expensive and carries risks including low calcium levels and nerve injury, Dr. Brito said in the release.

"Uncertainty about the benefits and harms of immediate treatment for low-risk papillary thyroid cancer should spur clinicians to engage patients in shared decision-making to ensure treatment is consistent with the research evidence and patient goals," Dr. Brito said.

Rather than calling these low-risk lesions “thyroid cancer” Dr. Brito recommended coining a new term that “connotes a favorable prognosis” for such low-risk cancers, suggesting calling them ‘microPapillary Lesions of Indolent Course (microPLIC)’ instead.  Re-naming the threat may make it easier for doctors to offer patients the choice of actively watching the lesions rather than seeking immediate and often risky treatment.

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