A small but growing number of patients
who are diagnosed with thyroid cancer choose not to intervene.
Overdiagnosis of cancer—the identification of cancers that are unlikely to progress or cause the patient any harm—is a source of discomfort and challenge for patients, physicians, and health care systems. Overdiagnosis is recognized to occur in patients with thyroid cancer, which has significant ramifications for population health. By the age of 50 years, half of the population has at least one thyroid nodule. By the age of 90, virtually everyone has at least one thyroid nodule, making the population at risk of being identified with a thyroid nodule, and thus a cancer, very large. In Japan, it has been recognized that many small thyroid cancers can be effectively managed by a strategy of active surveillance. The most recent clinical practice guidelines from the United States acknowledge the Japanese data but still recommend surgical intervention for these cancers. A small but growing number of patients who are diagnosed with thyroid cancer choose not to intervene, but this choice is not always accepted by the medical community or the patient’s family and friends.
BY THE AGE OF
HALF OF THE POPULATION HAS AT LEAST ONE THYROID NODULE.
This study of consisted of 22 semi-structured interviews with adults living with thyroid cancer over a six-month period. All of these adults did not have symptoms of thyroid cancer and had elected not to have surgical intervention. They reported that their decision not to intervene received little support or reassurance from health care providers and others, and many participants reported receiving skeptical, even derisive responses, such as being told they were “stupid,” “wrong,” or “crazy.” Due to this, the majority of participants reported keeping their diagnoses a secret to avoid criticism. A majority of participants expressed a desire to hear about others’ experiences of nonintervention or to connect with others going through a similar experience, yet only three individuals reported finding satisfactory support. At the time of the interviews, five of the patients had discontinued surveillance, which is the alternative to intervention.