Thyroid Cancer in South Korea

This article has recently been published in the New England Journal of Medicine as well as an accompanying article in the New York Times. Essentially patients in South Korea are screened for thyroid cancer. That means that patients attending their doctors with, say, a sore foot, will be encouraged to have a thyroid scan rather than just investigating patients with symptoms suggestive of thyroid disease such as a lump in the neck. This seems like a good idea, and one would imagine that picking up a cancer must be a good thing. The problem is that many, small, thyroid cancers are indolent and are, oddly enough, unlikely to cause problems. In fact, one study has shown that up to a third of people who have died of other causes will have tiny thyroid cancers present. These micro-papillary cancers will sit in the thyroid causing no trouble and are very unlikely to spread. However, when a doctor has diagnosed a cancer then it is difficult to ignore it and so a large number of patients, as shown in this study from Korea, may end up having unnecessary surgery. The problem with this is that of all patients who have operations, a small number will experience complications for example hoarseness of voice or injury to the parathyroids that sit behind the thyroid and regulate the calcium levels in the blood. 

A difficult conundrum and one that often needs careful discussion between patient and doctor.