Reclassified: From Thyroid Cancer to Good Cancer to Not Cancer

A recent New York Times article with the title, “It’s Not Cancer: Doctors Reclassify a Thyroid Tumor” (http://www.nytimes.com/2016/04/15/health/thyroid-tumor-cancer-reclassification.html) was a superficial discussion that sought to dumb down a recent scientific article from the Journal of the American Medical Association (JAMA) for the masses. The JAMA article has a slightly less sexy title, “Nomenclature Revision for Encapsulated Follicular Variant of Papillary Thyroid Carcinoma: a Paradigm Shift to Reduce Overtreatment of Indolent Tumors.” (http://oncology.jamanetwork.com/article.aspx?articleid=2513250) The New York Times article intentionally or unintentionally succeeds to suggest that many people that were treated for thyroid cancer were over treated and they didn’t actually have cancer after all and that this is newsworthy. This is a gross exaggeration and it’s dangerous.

 

Let me back up a bit for some background that was not described in the Times piece. There are four types of thyroid cancer. They are Papillary, Follicular, Medullary and Anaplastic Thyroid Cancer. Papillary thyroid cancer is the most common and accounts for 70% of the cases of thyroid cancer. (I had Papillary Thyroid Cancer.) Within Papillary thyroid cancer (PTC), there are many variants. The type and variant are determined by a pathologist after the offending thyroid gland has been removed. (Warning: this part gets a bit dry. Feel free to skim one line and skip to next paragraph if you choose.) Some variants of PTC are more common than others, but the variants include: Conventional, Follicular Variant (How confusing is that?), Papillary Microcarcinoma, Tall Cell, Oncocytic (This is what I had), Columnar Cell, Diffuse Sclerosing, Solid, Clear cell, Cribriform Morular, Macrofollicular, PTC with Prominent Hobnail Features, PTC with Fasciitis-Like Stroma, Combined Papillary and Medullary Carcinoma, PTC with Dedifferentiation to Anaplastic Carcinoma.

 

Are you still with me? I realize that this is super boring. That is why it was not included in the sensationalized New York Times article, but it is important. When we are talking about the type of thyroid cancer that was reclassified to not-cancer, it is not all kinds of thyroid cancer. It is very specific. Another way to further classify thyroid carcinomas is whether or not they are encapsulated. Intuitively a tumor that is within a capsule is going to be better behaved than one that is not. The thyroid cancer that was reclassified is the noninvasive Encapsulated Follicular Variant of Papillary Thyroid Carcinoma (EFVPTC). EFVPTC will henceforth be known as Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP). EFVPTC/NIFTP has been found to carry an excellent prognosis with surgery alone, so people with this diagnosis likely need a partial thyroidectomy (aka hemithyroidectomy) alone and then regular monitoring. This is really great for them because it means that they likely will have normal thyroid function and they don’t need radioactive iodine. However, here is my very unsexy headline: “A Subtype of a Variant of a Type of Thyroid Cancer has an Indolent Course”. How many people will this affect? Well, if you turn to the e-supplement section of the JAMA article, and go to table 7, you will find a list of the 5 retrospectives studies that look at the proportion of PTC cases that were classified as EFVPTC. The prevalence varies from 4.8-24.3% of the cases of PTC, with an average of 13.8%. PTC accounts for 70% of all cases of thyroid carcinoma, so this new classification will affect <10% of Thyroid Cancer patients. The other 90% still have cancer.

 

Here is why I think that the New York Times piece is dangerous, it gives the sense that thyroid cancer is not cancer. It gives the sense that a lot of people have been over treated for and diagnosed with thyroid cancer. It suggests that thyroid cancer survivors are not cancer survivors. The Thyroid Cancer Survivors were already a marginalized group in the Survivor community. Thyroid cancer is stigmatized for being such good cancer. I have never felt that my cancer was cancery enough to say I am a survivor. I think that a lot of thyroid cancer survivors suffer from Cancer Survivor Imposter Syndrome (CSIS). But having two surgeries to have your entire thyroid removed and radioactive iodine feels pretty cancery to me. Worrying every time that you feel an enlarged lymph node in your neck that you might have a recurrence and struggling to get your thyroid medication dose right also feels pretty real. The New York Times piece makes the Cancer Survivor Imposter Syndrome worse. It reinforces the feeling that occurs within and outside the Thyroid Cancer community that thyroid cancer is no biggie. I can’t wait for someone to tell me that my good cancer is not even cancer.

 

So if you are looking for credible medical information, I would suggest a peer-reviewed medical journal with a high impact factor. If you are looking for a light read to skim on your smart phone with fun health stories so that you can glean a random pseudo-fact about a disease that you don’t have and doesn’t affect you, go with a New York Times health piece.