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
If the thyroid is normal, a ridged area will be visible on the neck
If bulges or protrusions are seen instead, the thyroid should be checked
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.
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.