Erratic Cancer Treatment Patterns

Thyroid cancer radioactive iodine treatment varies by hospital

(RxWiki News) Physicians don't always follow recommended guidelines for screenings, diagnostic testing or treatment. Apparently, this sort of confusion is being seen in thyroid cancer treatment.

Whether or not a thyroid cancer patient receives radioactive iodine treatment often has more to do with the treating hospital than the disease itself. That's what a new study from the University of Michigan (U-M) Comprehensive Cancer Center has uncovered.

"Question the use of radioactive iodine for early stage thyroid cancer."

The severity and size of the tumor should be the primary considerations in treatment decisions. However, according to lead study author, Megan Haymart, M.D., assistant professor of internal medicine at the U-M Medical School, in addition to the state of the tumor, where a person receives care also determines the use of radioactive iodine.

Thyroid cancer treatment usually involves surgery to remove the tumor or the entire gland. Radioactive iodine is known to be effective after surgery in advanced cases of the disease, or when the cancer is likely to return.

However, for smaller, lower-risk tumors, radioactive iodine may not be necessary. Most patients have a very positive outlook without such treatment that can have serious long-term side effects including the risk of second cancers and damage to surrounding tissues.

Dr. Haymart's team examined data of 189,219 patients diagnosed with thyroid cancer between 1990 and 2008. This information came from the National Cancer Database.

Here's what the study found about the use of radioactive iodine:

  • Overall use has increased
  • In 1990 40 percent of patients received it
  • In 2008, 56 percent of patients were treated with it
  • Tumor size and severity accounted for 21 percent of the variations in care seen
  • Hospitals that treated a large number of thyroid cancer patients also was a factor in the different treatment patterns
  • 29 percent of the variations could not be explained

Dr. Haymart said that these variations were seen even among high-risk patients for whom the treatment guidelines are clear.

She concludes that doctors apparently are uncertain about the indications and guidelines for ordering this treatment. Dr. Haymart adds that clinical trials are needed to look at radioactive iodine in low-risk patients so that guidelines can be refined if necessary.

One of the 10 most common forms of cancer among Americans, thyroid cancer is expected to become even more prevalent thanks to earlier and better diagnostic tools.

According to the American Cancer Society, 44,670 people in the United States will be diagnosed with thyroid cancer in 2011, and 1,690 will die from it.

Results of this study are published in the Journal of the American Medical Association.

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Review Date: 
August 18, 2011