- Email: [email protected]
Thyroid cancer subtype downgraded to non-cancer
News
Thyroid cancer subtype downgraded to non-cancer Encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC) has been reclassified as non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), an international panel has announced. Improvements in diagnosis have led to the incidence of EFVPTC doubling or tripling in the past 20 to 30 years in Europe and North America. However, the number of people dying from this cancer has not increased at the same rate, suggesting that many patients are being overdiagnosed. To explore this issue further, the panel independently reviewed 268 tumour samples diagnosed as EFVPTC. They established diagnostic criteria, which included cellular features, tumour invasion, and other factors. In tumour samples from 109 patients with non-invasive EFVPTC, the team found no recurrences or other evidence of disease, and all the patients were
alive at a median follow-up of 13 years. The panel agreed that EFVPTC presents a very low risk to patients and should be renamed NIFTP. Lead author Yuri Nikiforov (University of Pittsburgh, PA, USA said: “This re-classification will affect 20% of patients with thyroid cancer currently diagnosed in Europe and the USA. It will result in not labelling these patients with cancer and so avoiding the physiological stress that this can cause.“ Nikiforov continued: “Clinically, these patients will not have to undergo second surgery, they will not need radioactive iodine therapy, or check-ups every 6–12 months for the rest of their life. This should result in substantial savings in healthcare spending”, he said. “We hope, and expect, that this study will pave the way for groups of experts working on other cancer types where
overdiagnosis and overtreatment of indolent tumour types and early cancers is well documented to reclassify those”, he concluded. Otis Brawley, from the American Cancer Society (Atlanta, GA, USA), said: “We are in the midst of redefining what cancer is. The old definitions of cancer no longer apply and we need to start changing the mindset that all cancers are aggressive and will kill you. There are things that look like cancer but genomically won’t behave like cancer. “Researchers have long debated whether Gleason 6 prostate cancer should be called a cancer. Very few men with this end up being bothered by the cancer. But no one wants to say to those patients who have already been diagnosed that they have been falsely classified.”
Lancet Oncol 2016 Published Online April 21, 2016 http://dx.doi.org/10.1016/ S1470-2045(16)30089-4 For the study by Nikiforov and colleagues see JAMA Oncol 2016; published online April 14. DOI:10.1001/ jamaoncol.2016.0386
Sanjay Tanday
www.thelancet.com/oncology Published online April 21, 2016 http://dx.doi.org/10.1016/S1470-2045(16)30089-4
1
Thyroid cancer subtype downgraded to non-cancer Encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC) has been reclassified as non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), an international panel has announced. Improvements in diagnosis have led to the incidence of EFVPTC doubling or tripling in the past 20 to 30 years in Europe and North America. However, the number of people dying from this cancer has not increased at the same rate, suggesting that many patients are being overdiagnosed. To explore this issue further, the panel independently reviewed 268 tumour samples diagnosed as EFVPTC. They established diagnostic criteria, which included cellular features, tumour invasion, and other factors. In tumour samples from 109 patients with non-invasive EFVPTC, the team found no recurrences or other evidence of disease, and all the patients were
alive at a median follow-up of 13 years. The panel agreed that EFVPTC presents a very low risk to patients and should be renamed NIFTP. Lead author Yuri Nikiforov (University of Pittsburgh, PA, USA said: “This re-classification will affect 20% of patients with thyroid cancer currently diagnosed in Europe and the USA. It will result in not labelling these patients with cancer and so avoiding the physiological stress that this can cause.“ Nikiforov continued: “Clinically, these patients will not have to undergo second surgery, they will not need radioactive iodine therapy, or check-ups every 6–12 months for the rest of their life. This should result in substantial savings in healthcare spending”, he said. “We hope, and expect, that this study will pave the way for groups of experts working on other cancer types where
overdiagnosis and overtreatment of indolent tumour types and early cancers is well documented to reclassify those”, he concluded. Otis Brawley, from the American Cancer Society (Atlanta, GA, USA), said: “We are in the midst of redefining what cancer is. The old definitions of cancer no longer apply and we need to start changing the mindset that all cancers are aggressive and will kill you. There are things that look like cancer but genomically won’t behave like cancer. “Researchers have long debated whether Gleason 6 prostate cancer should be called a cancer. Very few men with this end up being bothered by the cancer. But no one wants to say to those patients who have already been diagnosed that they have been falsely classified.”
Lancet Oncol 2016 Published Online April 21, 2016 http://dx.doi.org/10.1016/ S1470-2045(16)30089-4 For the study by Nikiforov and colleagues see JAMA Oncol 2016; published online April 14. DOI:10.1001/ jamaoncol.2016.0386
Sanjay Tanday
www.thelancet.com/oncology Published online April 21, 2016 http://dx.doi.org/10.1016/S1470-2045(16)30089-4
1