When Is Papillary Thyroid Cancer a Real Cancer?

When Is Papillary Thyroid Cancer a Real Cancer?

Majid Ali, M.D.

This question concerns a matter of personal spiritual realism as it is of the science of pathology and biology of papillary thyroid cancer. Individuals who ignore the first issue of spirituality often needlessly get herded to operating rooms and radiotherapy tables. At the levels of pathology and biology, I address the matter in three ways. As for the spiritual dimension, please read my article entitled Personal Spiritual Realism” at this website.

In mid-1960s, as a young surgeon in England I first heard an older surgeon say that he does not understand papillary cancer of the thyroid gland. In late 1960s, I began to see things more clearly when, as a pathology resident in the United States, I heard myself say that I had to have a cancer in my body, I would like it in my thyroid gland and that cancer to be of papillary type. (I must have heard it said by my professors one too many times). The important point there is: pathologist rarely perform autopsies on people dying of papillary thyroid cancer. Now fast forward to 2014.

So, When Is Papillary Thyroid Cancer a Real Cancer?

Consider the following quote from an older physician in The New York Times of November 17, 2014:

“Here are some facts to mull over: Pathologists have found that the chance that an adult has a thyroid nodule is about the same as one’s age, so a 50-year-old would have a 50 percent probability of having a thyroid nodule. Only about 10 percent of these nodules ever become clinically evident, and only about 6 percent of clinically evident nodules are malignant, so the chance of a 50-year-old’s having thyroid cancer is about one in 300.

The mortality rate is about 5 percent, so the chance of such a person’s dying of thyroid cancer is about 1 in 6,000.

Long-term smokers have a one in 10 chance of getting lung cancer, with its high mortality rate. Think aboLong-term smokers have a one in 10 chance of getting lung cancer, with its high mortality rate. Think about it.”

Thank you, Dr. David Charkes (retired director of the Thyroid Center of Temple University Medical School.)

Did I Do the Right Thing to Have Thyroid Surgery?

Next consider the following from the Times of the same day:

It was bittersweet to have these two articles appear the day before my thyroid surgery, and to be reading them the day after. They validate the months of confusion and exhausting deliberations since I received a diagnosis of a tiny papillary microcarcinoma, but they also make me question again if I did the right thing in taking it out.

I hope this coverage leads both doctors and patients to think carefully before doing a fine-needle aspiration biopsy, or even an ultrasound, as once you go there, you are on a very slippery slope toward overtreatment. Once you know it is there, it is incredibly hard to sit on a cancerous growth, even one with very low rates of metastasis and mortality. The reality is that no one can say for sure if I had unnecessary surgery or if I saved my life by being proactive and removing the lesion before it metastasized.

I feel fortunate that my endocrinologists and surgeon at Boston Medical Center were responsive to my needs, were willing to consider all the options, and did a lobectomy rather than a total thyroidectomy. Cancer is inevitably very stressful, but it could have been less so if I had understood up front what the repercussions were of having the biopsy and if the standard of care had been revised to include watching and waiting as a medically justified treatment choice. Miliann Kang.”

Can Anyone Say for Sure If Having Non-Emergency Coronary Artery Stent Was Really Necessary?

The above question wrote in my mind when I read Ms. Kang’s following words: think carefully before carefully before doing a non-emergency coronary angiogram. Once you go there, you are on a very slippery slope toward overtreatment..

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