The Relationship Between Imaging and Thyroid Cancer Diagnosis and Survival

BackgroundControversy exists over whether there has been a true increase in the occurrence of thyroid cancer or overdiagnosis secondary to imaging practices. Because cancer overdiagnosis is associated with detection of indolent disease, overdiagnosis can be associated with perceived improvement in survival.Materials and MethodsSurveillance, Epidemiology, and End Results- Medicare linked database was used to determine the relationship between type of imaging leading to thyroid cancer diagnosis and survival. Disease- specific and overall survival were evaluated in 11,945 patients aged - ¥66- years with differentiated thyroid cancer diagnosed between January 1, 2001, and September 30, 2015, who prior to their cancer diagnosis initially underwent thyroid ultrasound versus other imaging capturing the neck. Analyses were performed using the Kaplan- Meier method and Cox proportional hazards model with propensity score.ResultsPatients who underwent thyroid ultrasound as compared with other imaging had improved disease- specific and overall survival (p < .001, p < .001). However, those who underwent thyroid ultrasound were less likely to have comorbidities (p < .001) and more likely to be younger (p < .001), be female (p < .001), have localized cancer (p < .001), and have tumor size - ¤1 cm (p < .001). After using propensity score analysis and adjusting for tumor characteristics, type of initial imaging still correlated with better overall survival but no longer correlated with better disease- specific survival.ConclusionThere is improved disease- specific survival in patients diagnosed with thyroid cancer after thyroid ultrasound as compared with after other imaging. However, better disease- specific survival is related to these patients being younger and healthier and having lower- risk cancer, suggesting that thyroid ultrasound screening contributes to cancer overdiagnosis.Implications for PracticeThe findings from this study have implications for patients, physicians, and policy makers. Patients who have thyroid ultrasound as their initial imaging are fundamentally different from those who are diagnosed after other imaging. Because patients undergoing ultrasound are younger and healthier and are diagnosed with lower- risk thyroid cancer, they are less likely to die of their thyroid cancer. However, being diagnosed with thyroid cancer can lead to cancer- related worry and create risks for harm from treatments. Thus, efforts are needed to reduce inappropriate use of ultrasound, abide by the U.S. Preventive Services Task Force recommendations, and apply nodule risk stratification tools when appropriate.Because cancer overdiagnosis can be associated with both earlier detection and the detection of slower- growing tumors, overdiagnosis can lead to perceived improvement in survival. This article reports on the relationship between type of imaging and survival, using SEER- Medicare data to assess the initial imaging associated with cancer detection and disease- specific and overall survival.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/162764/2/onco13329_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/162764/1/onco13329.pd

Risk of Osteoporosis and Fractures in Patients with Thyroid Cancer: A Caseâ Control Study in U.S. Veterans

BackgroundData on osteoporosis and fractures in patients with thyroid cancer, especially men, are conflicting. Our objective was to determine osteoporosis and fracture risk in U.S. veterans with thyroid cancer.Materials and MethodsThis is a caseâ control study using the Veterans Health Administration Corporate Data Warehouse (2004â 2013). Patients with thyroid cancer (n = 10,370) and controls (n = 10,370) were matched by age, sex, weight, and steroid use. Generalized linear mixedâ effects regression model was used to compare the two groups in terms of osteoporosis and fracture risk. Next, subgroup analysis of the patients with thyroid cancer using longitudinal thyroidâ stimulating hormone (TSH) was performed to determine its effect on risk of osteoporosis and fractures. Other covariates included patient age, sex, median household income, comorbidities, and steroid and androgen use.ResultsCompared with controls, osteoporosis, but not fractures, was more frequent in patients with thyroid cancer (7.3% vs. 5.3%; odds ratio [OR], 1.33; 95% confidence interval [CI], 1.18â 1.49) when controlling for median household income, Charlson/Deyo comorbidity score, and androgen use. Subgroup analysis of patients with thyroid cancer demonstrated that lower TSH (OR, 0.93; 95% CI, 0.90â 0.97), female sex (OR, 4.24; 95% CI, 3.53â 5.10), older age (e.g., â ¥85 years: OR, 17.18; 95% CI, 11.12â 26.54 compared with <50 years), and androgen use (OR, 1.63; 95% CI, 1.18â 2.23) were associated with osteoporosis. Serum TSH was not associated with fractures (OR, 1.01; 95% CI, 0.96â 1.07).ConclusionOsteoporosis, but not fractures, was more common in U.S. veterans with thyroid cancer than controls. Multiple factors may be contributory, with low TSH playing a small role.Implications for PracticeData on osteoporosis and fragility fractures in patients with thyroid cancer, especially in men, are limited and conflicting. Because of excellent survival rates, the number of thyroid cancer survivors is growing and more individuals may experience longâ term effects from the cancer itself and its treatments, such as osteoporosis and fractures. The present study offers unique insight on the risk for osteoporosis and fractures in a largely male thyroid cancer cohort. Physicians who participate in the longâ term care of patients with thyroid cancer should take into consideration a variety of factors in addition to TSH level when considering risk for osteoporosis.Thyroid stimulating hormone suppression therapy may contribute to bone loss in patients with thyroid cancer, especially in postmenopausal women. The link between thyroid cancer treatment and osteoporosis and fractures in men is less certain. This article reports results of a study designed to address this knowledge gap.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151904/1/onco12999-sup-0002-Tables.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151904/2/onco12999-sup-0001-supinfo.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151904/3/onco12999_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151904/4/onco12999.pd

Disparities in risk perception of thyroid cancer recurrence and death

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154276/1/cncr32670.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154276/2/cncr32670_am.pd