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Article Dans Une Revue Cancer Année : 2019

Reply to Natural history of thyroid cancer suggests beginning of the overdiagnosis of juvenile thyroid cancer in the United States and Harm of overdiagnosis or extremely early diagnosis behind trends in pediatric thyroid cancer.

Cari Kitahara
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Meredith Shiels
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Résumé

Midorikawa et al. (1) and Takano (2) expressed concerns about our interpretation and the broader implications of our study (3), describing trends in U.S. paediatric differentiated thyroid cancer incidence rates between 1998 and 2013 (3). We found that the incidence of differentiated thyroid cancer increased rapidly over the study period, for all tumor stages and sizes at diagnosis. Most cases were localized to the thyroid gland at diagnosis, and these accounted for the largest absolute increase in incidence over time. Overdiagnosis, or the diagnosis of cancers that would have never become symptomatic or caused health problems over a lifetime, has likely had the greatest influence on trends in localized tumors. More intensive diagnostic evaluation has resulted in a higher prevalence of detected thyroid nodules, worked up with biopsies that may result in thyroid cancer diagnoses. Thyroid cancer overdiagnosis and overtreatment are major clinical and public health concerns, especially for young patients with long life expectancies post-treatment. However, the large and significant increase in distant (i.e., with extracervical metastasis) differentiated thyroid cancer is incompatible with overdiagnosis being the only factor contributing to increasing thyroid cancer incidence. Takano suggested that even metastatic thyroid cancer could be overdiagnosed in paediatric patients since cancer cells are likely to stop proliferation after metastasis (2). However, survival of paediatric thyroid cancer is worse in the presence of distant metastases (5,6), and U.S. guidelines recommend aggressive treatment - surgery combined with radioactive iodine (7). While a critical evaluation of current guidelines may be warranted to ensure that these patients are not being unnecessarily subjected to treatment-related risks, we disagree that overdiagnosis applies to metastatic differentiated thyroid cancer. The significant increase in paediatric thyroid cancers with regional invasion is more difficult to interpret, as these include cases with minimal cervical lymph node involvement that will not become more aggressive and those with significant cervical lymph node involvement that may become more aggressive.Our results strongly support ongoing efforts to prevent the overdiagnosis of thyroid cancer in paediatric and adult patients. These include initiatives to improve risk stratification tools to restrict screening of thyroid cancers to patients who would likely benefit most from treatment. Concurrently, our observation of a strong temporal increase in distant thyroid cancer incidence appears compatible with a changing prevalence of exposure to lifestyle-related or environmental risk factors. Thus, both overdiagnosis and a true increase in the occurrence of paediatric differentiated thyroid cancer likely have contributed to overall trends in the United StatesA common goal is a desire to reduce the overall burden of thyroid cancer, especially in paediatric patients, requiring prevention efforts focused on the occurrence and progression of thyroid cancer. However, thyroid cancer etiology remains poorly understood, with few known modifiable risk factors apart from childhood ionizing radiation exposure and obesity. The implementation of effective interventions requires the identification of modifiable risk factors and causal mechanisms through epidemiologic and experimental research. Progress in this area will complement and not undermine efforts aimed at reducing thyroid cancer overdiagnosis.

Dates et versions

hal-02982039 , version 1 (28-10-2020)

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Citer

Marie Odile Bernier, Cari Kitahara, Meredith Shiels. Reply to Natural history of thyroid cancer suggests beginning of the overdiagnosis of juvenile thyroid cancer in the United States and Harm of overdiagnosis or extremely early diagnosis behind trends in pediatric thyroid cancer.. Cancer, 2019, 125 (22), pp.4109-4110. ⟨10.1002/cncr.32425⟩. ⟨hal-02982039⟩
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