Ultrasound scans increase cancer diagnosis rate
There are concerns about overdiagnosis, but it is necessary… found more in women than men
Although the progression is slow and the prognosis is good, customized treatment is required depending on the nature of the cancer
“The Dong-A Ilbo has significantly strengthened online and offline health contents to mark the 102nd anniversary of its foundation. In line with the opening of the health platform ‘Health Donga’ on Donga.com (www.donga.com), they prepared a plan for ‘Women’s Cancer Recommended by Myunggi’. The third is thyroid cancer.”
What kind of doctor do people with thyroid cancer (thyroid cancer) go to if they get thyroid cancer? The Dong-A Ilbo recently received recommendations from 52 people with thyroid cancer in Korea who they can trust when they or their family members get thyroid cancer. A total of 275 people recommended them. Among them, Professor Won-bae Kim of the Department of Endocrinology at Seoul Asan Hospital and Professor Hang-seok Jang of Thyroid Endocrine Surgery at Gangnam Severan Hospital jointly took the first place. This time, I went to see Professor Kim.
Professor Kim led the work of making recommendations for the treatment of thyroid nodules and cancer of the Korean Endocrinology Society in 2006, when there was no standardized treatment guideline for thyroid cancer. He was the first to establish that Graves’ disease, a type of hyperthyroidism, has a variety of genetic causes, which affects treatment. He currently serves as the 10th President of the Asia-Oceanian Thyroid Society.
What is the reason that women have a higher incidence of thyroid cancer than men?
“If you look at the incidence of thyroid cancer in general, women are three to five times more likely than men. The reasons why there are so many women are still not exactly known. However, when cancer occurs, an anticancer immune response occurs within the body, and since a woman goes through the process of pregnancy and childbirth, there is ‘immune tolerance’ that slightly dulls the immune response when other tissues enter the body. Cancer is, after all, a different tissue, so I think there will be such an effect.”
―Is the increase in thyroid cancer due to frequent ultrasound scans?
“It is right and it is wrong. Small thyroid cancer is very common. About 5% of adults have it. Ultrasonography can detect even very small cancers, raising concerns about overdiagnosis. However, on the other hand, even if the thyroid cancer is quite large, it is often not detected without an ultrasound examination. Ultrasound is a very important tool for early diagnosis of thyroid cancer. Because of this, it is difficult to tell them not to do an ultrasound in advance.”
―If there is a difference between the treatment of thyroid cancer in the past and the present… .
“In 2006, we made recommendations for the treatment of thyroid cancer nodules and cancer. However, at present, if the guidelines are followed, there are too many diagnoses and treatments for thyroid cancer. These days, small cancers are left untreated or the scope of surgery is reduced as much as possible. Radioiodine treatment should also be reduced if possible. That’s because it doesn’t make a huge difference in survival rates.”
―There are many departments that treat thyroid cancer, so it is confusing.
“Since thyroid cancer appears as a nodule, it is necessary to go through several stages from the diagnosis of nodule to whether or not to have surgery, what kind of surgery to do, and whether to receive radioactive iodine treatment after surgery. It is usually managed comprehensively by the internal medicine department, so if you want to receive self-management for the rest of your life, it is better to see the internal medicine department. The most important treatment for thyroid cancer is surgery. When it comes to surgery, it is done by a surgeon or an otolaryngologist.”
―If there are any precautions to be taken while taking thyroid hormone drugs… .
“Thyroid hormones are poorly absorbed, so they are usually taken on an empty stomach. You should wait for at least 30 minutes or an hour before eating, and if you eat right away, the absorption of the drug is less. The same goes for other drugs. In particular, preparations containing iron or calcium may interfere with the absorption of thyroid hormones, so taking them together should be avoided. In addition to these, female hormone preparations, drugs used in neurology or psychiatry, and some anti-tuberculosis drugs also affect the blood level of thyroid hormone, so it is advisable to consult with your doctor before taking it.”
―If there is any advice you would like to give to patients… .
“Thyroid cancer progresses so slowly that it is called ‘turtle cancer’. However, thyroid cancer has many different spectrums. In the case of undifferentiated cancer, the progression is rapid and the prognosis is poor. Since the treatment method is different depending on the stage of the cancer, it is important to receive the appropriate treatment for your situation. After that, there is no need to have excessive fear of ‘I am not going to die from this cancer’. This is because the prognosis is very good, so that death from cancer is rare if surgery is performed properly and then is treated appropriately.”
Myths and truths of thyroid cancer (thyroid cancer) from Professor Wonbae Kim, Department of Endocrinology, Asan Hospital, Seoul
Eating a lot of seaweed reduces the effects of thyroid hormones.
NO For underlying diseases such as Hashimoto’s thyroiditis, eating a lot of seaweed can lead to an increase in iodine intake, which can lead to hypothyroidism. Otherwise, even if you eat a lot of seaweed, there is no significant effect on the thyroid function.
Frequent exposure to radiation can lead to thyroid cancer.
YES It is well known that radiation plays an important role in the development of thyroid cancer. Many thyroid cancers have occurred in the past atomic bomb victims. Exposure to radiation in children is more likely to cause thyroid cancer than adults. In particular, it is known that thyroid cancer increases when irradiating the head and neck or thyroid gland for treatment of head and neck cancer or blood cancer in children.
If you have thyroid hormone disorders, you are more likely to develop thyroid cancer.
NO If there is hyperthyroidism or hypothyroidism, patients go to the hospital, and there are many tests at this time. In the process, the diagnosis of thyroid cancer is better, but having thyroid hormone disease does not increase the risk of cancer.
Thyroid cancer is hereditary.
NO About 5% of cases of thyroid cancer are familial. However, most of them have nothing to do with family history. And since many environmental factors also play a role, even if it is a familial cancer, it is not a genetically occurring cancer.
Thyroid cancer patients live longer.
NO Since thyroid cancer is usually detected early, the 5-year survival rate in Korea is as high as 98%. However, Japan and Europe have lower 5-year survival rates of 92% and 87%, respectively. Therefore, it has already been found statistically that the mortality rate is higher compared to those without thyroid cancer.
Lee Jin-han Medical Correspondent Doctor likeday@donga.com
By Hong Eun-shim, staff reporter hongeunsim@donga.com