By Raymon Grogan, MD
It is now accepted by most in the medical community that the rate of thyroid cancer in the United States has been steadily increasing for several decades.
In fact, published reports from almost every cancer registry in the world show similar increases, making this a global phenomenon.
What remains controversial, though, is the cause.
Some have proposed that there’s not an actual increase in new cancers, but rather physicians have become better at detecting small tumors that may have gone undiagnosed in the past.
Conversely, there are those who believe that it’s not just better diagnosis, but that something has fundamentally changed about thyroid cancer on a population level that is causing more and more people to develop these tumors.
There are several theories behind what might be causing thyroid cancer rates to increase. One of the more interesting is the rising levels of so-called endocrine disruptors making their way into the environment.
Ubiquitous Endocrine Disruptors Can Lead to Various Abnormalities
These compounds are used in the production of a number of household items, such as plastic bottles, metal food cans, detergents, food, toys, cosmetics and pesticides.
They are ubiquitous in the environment. And they have been shown to interfere with the body’s endocrine function, leading to developmental, reproductive, neurologic, and immune abnormalities.
At this point we do not know if these compounds might also have a carcinogenic effect on endocrine organs.
Exposure to low doses of radiation for long periods of time is another possible environmental cause.
We know the thyroid is very susceptible to radiation, and short-term exposure to higher doses can cause thyroid cancer. What we do not know is what long-term exposure to very low doses of radiation does to the thyroid.
This debate is being played out in the medical literature, with articles being published supporting both sides of this argument.
While it’s true that we are detecting small thyroid cancers earlier, the diagnosis of very large thyroid cancers is also increasing. This suggests that the cause is multifactorial, so there’s truth on both sides of the argument.
Regardless of the Causes, Costs are Rising
Unfortunately, the discussion over why this is occurring has overshadowed the equally important consequences of such rising cancer rates. The bottom line is that once a patient has been diagnosed he or she will go on to have some form of treatment.
This has lead to increasing costs that have gone largely unrecognized. We recently published data showing that if these trends continue, thyroid cancer care will cost nearly $20 billion over the next 10 years in the United States alone, compared with about $1.4 billion in 2010.
But even more important are the “hidden” social costs associated with these rising cancer rates, such as lost time from work for needed treatment, but also lost time and productivity caused by the psychological stress associated with being diagnosed with cancer.
At the recent American Society of Clinical Oncology (ASCO) meeting, a paper was presented showing that cancer survivors have higher rates of bankruptcy than the general population. And those diagnosed with thyroid cancer top that list.
Unfortunately, research on the psychological impact of surviving thyroid cancer is sparse. Only a handful of articles on the topic have been published in the medical literature, and the majority of that work has been done on populations outside of North America.
Because a person’s cultural background influences their coping mechanisms, you can’t extrapolate the findings and apply them to patients here. For example a recent survey of thyroid cancer survivors from Singapore found that ethnicity had a significant impact on a patient’s survey scores for pain, social function, mental health, and emotional health.
Furthermore, thyroid cancer is somewhat unique in that patients with the most common form, papillary thyroid cancer, have very good long-term survival rates, but a relatively high likelihood of recurrence (upwards of 30% over a lifetime).
A common approach to thyroid cancer treatment is surgery on the neck followed by radioactive iodine therapy. But that can result in side effects that differ from those of other cancers, such as breast or prostate cancer.
For example, thyroid cancer patients have to worry about loss of voice function or permanent deleterious electrolyte abnormalities, two things that are very specific to thyroid cancer survivors.
Radioactive iodine is also very specific to thyroid cancer survivors, and is not used for the treatment of other tumors. There may be some necessary precautions associated with this type of treatment.
Plus, the scar from the surgical incision is usually visible, while scars from other surgeries can be hidden from view.
Study to Examine Psychological Impact of Rising Cancer Rates
Without knowing how a thyroid cancer diagnosis changes a person’s psychological well being, physicians are limited in the range of options they can offer their patients. Psychological support is a critical part of any long-term cancer survivorship program.
And as thyroid cancer rates continue to climb, more and more people are becoming thyroid cancer survivors.
To try and understand this growing problem, I’ve partnered with University of Chicago epidemiologist Brisa Aschebrook-Kilfoy, PhD, to conduct a multi-institutional trans-North American clinical trial to assess the psychological impact of thyroid cancer survivorship.
By selecting several sites throughout North America we hope to enroll several thousand thyroid cancer survivors to assess exactly what happens psychologically to a thyroid cancer survivor over several decades after their initial diagnosis.
Among the questions we‘re seeking to answer:
• How often does a thyroid cancer patient think about their diagnosis and worry about the cancer returning?
• Do they worry that their family members might also develop thyroid cancer?
• Do they worry that their diagnosis has caused a burden on their family, or has changed the family dynamic?
• Have the side-effects of treatment impacted their life in any way?
The project was funded in part by a grant from the Bucksbaum Institute for Clinical Excellence at the University of Chicago, which has helped us establish the study design, recruit the other participating sites into the study, and begin to collect preliminary data.
With these data we anticipate being able to help physicians better understand their patients, while providing new patient resources to better care for people who have been affected by this “hidden” consequence of thyroid cancer.
Raymon Grogan, MD, is a specialist in the surgical management of thyroid, parathyroid, and adrenal gland diseases. He has expertise in the surgical management of endocrine cancers as well as benign endocrine gland disorders. As a clinician and a scientist, Dr. Grogan is actively involved in clinical, translational, epidemiological, and basic science research.