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Neck Check Exam Aims at Early Detection

Neck Check Exam Aims at Early Detection

NEW YORK--Thyroid cancer is diagnosed in an estimated 15,600 Americans every year. As with many cancers, early detection is the key to effective treatment. Yet because thyroid cancer is asymptomatic, an enlarged thyroid or nodule on the gland is often the only sign that a malignancy is present.

A simple self-examination technique will enhance early detection, according to the American Association of Clinical Endocrinologists (AACE). At a press briefing, Stanley Feld, MD, of the University of Texas Southwestern Medical School, Dallas, introduced the new "neck check" examination and the slogan, "Stick Your Neck Out, America."

Calling it the "forgotten cancer," Dr. Feld, who is co-chair of the AACE Thyroid Cancer Guidelines Task Force, said that public awareness of thyroid cancer is low, despite the fact that it is twice as common as Hodgkin's disease and strikes as many people as multiple myeloma and cervical, liver, and esophageal cancers.

"Between 50% and 60% of the American population has thyroid nodules, of which as many as 10% are cancerous," Dr. Feld said. "But of an estimated 3 million thyroid cancers, fewer than 16,000 are diagnosed each year." The opportunity for effective treatment and, in many cases, cure is thus lost to many.

With proper treatment, thyroid cancer has a high survival rate, Dr. Feld noted. "There are an estimated half million thyroid cancer patients in the United States alive today, including many whose cancers were diagnosed and treated more than 40 years ago," he said.

The association calls on physicians to join the public education campaign by teaching the self-examination technique. Dr. Feld emphasized that abnormalities found through the self-exam could be either an enlarged thyroid or a malignant growth. Referral should be made to a clinical endocrinologist for a full evaluation, including a fine-needle aspiration biopsy of the thyroid to determine whether cancer is present.

Performing the Neck Check

The thyroid self-examination, which should be performed monthly, requires only a hand-held mirror and a glass of water. The individual holds the mirror so that the area of the neck just below the Adam's apple is visible, then tips back the head. After taking a sip of water, the person swallows while looking at the neck.

If the thyroid is normal, a ridged area will be visible on the neck as the larynx moves with the swallowing action.

If bulges or protrusions are seen instead, the thyroid should be checked by a medical professional.

AACE recommends the neck check be done once a month, and hopes that it will become as routine as breast self-examination. Thyroid cancer most commonly strikes between the ages of 25 and 65, but even children should be taught to do the neck check, Dr. Feld said. Further, he said, it should be part of the routine medical examination. Physicians are urged to look first and palpate only after observing the neck while the patient swallows.

High-Risk Populations

People exposed to external radiation to the head and neck, a relatively common practice until the 1950s, are at greatest risk for developing thyroid cancer, he said. With its long latency period, thyroid cancer is showing up in patients who are now middle-aged.

Less commonly, some medullary thyroid carcinomas (MTC) may be familial and may be associated with one of the multiple endocrine neoplasia syndromes (MEN-2A and MEN-2B). For individuals with a family history of MTC, genetic testing can be performed and, if a RET oncogene mutation is found, elective prophylactic thyroidectomy may be recommended.

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