Wealth Influences Thyroid Cancer Diagnoses in São Paulo, Study Finds

Rethinking Thyroid Cancer Treatment: When Surgery May Be More Harmful Than the Disease, Ablation, and Observation Emerge as Preferable Alternatives

Overscreening and overdiagnosis

In the affluent corners of São Paulo State, the diagnosis rates for thyroid cancer outpace those in less wealthy regions, a phenomenon that researchers are attributing to overdiagnosis due to more frequent and advanced screening, according to a study published in the journal Endocrine Practice.

The disparities were uncovered in a study by a team from the Hospital de Amor, situated in the state’s northern expanse, and their colleagues at the International Agency for Research on Cancer, a branch of the World Health Organization. 

[The research, bolstered by funding from the São Paulo Research Foundation (FAPESP) through projects 17/03787-2 and 21/10806-9, delves into the incidence and mortality rates of the most common malignancy of the endocrine system—thyroid cancer.]

“Thyroid cancer has traditionally been seen as an affluent disease, more common in well-resourced nations,” explained Adeylson Guimarães Ribeiro, the study’s lead author and Deputy Director of Information and Epidemiology at the São Paulo Cancer Foundation. 

Is thyroid cancer the rich man’s disease?

“However, what we’re observing in Brazil, a nation with a burgeoning middle-class population, is that even in a developing country, the more affluent areas are showing higher diagnosis rates.”

In an eye-opening comparison, São Paulo City reported an incidence rate of 15.9 per 100,000 inhabitants, triple that found in the Barretos region. To put this in perspective, the national average in Brazil stands at 4.8, as per the National Cancer Institute, and the global rate is 6.6, according to the Global Cancer Observatory.

“The high incidence rates in São Paulo can likely be chalked up to overdiagnosis,” Ribeiro continued. “We have individuals being diagnosed with tumors that may not have caused symptoms or led to death had they gone undetected.”

Overdiagnosis

This phenomenon of overdiagnosis, the detection of tumors that might not otherwise cause clinical symptoms, has been highlighted as a potential downside of extensive cancer screening programs. It can lead to unnecessary treatments, with a variety of physical and psychological consequences for patients.

Mortality rates are near 0 – what are we curing?

Despite the stark differences in diagnosis rates, the study observed that mortality rates remained low and consistent across different regions and socioeconomic statuses, at 0.3%-0.4%. These findings suggest that increased screening does not necessarily translate to improved survival rates but may lead to the over-treatment of tumors that would have remained asymptomatic.

“The thrust of our findings is not to diminish the importance of cancer screening,” Ribeiro clarified, “but to prompt a reevaluation of our diagnostic protocols. Our aim should be to enhance the lives of patients, not to burden them with the anxiety and side effects of unnecessary treatments.”

These results underscore the intricate relationship between socioeconomic factors and health outcomes, and the researchers call for a recalibration of screening practices to better align with patients’ needs.

The implications of the study extend beyond the borders of Brazil, gesturing at a global trend that necessitates a balance between vigilant cancer screening and the avoidance of overmedicalization.

Source: “Thyroid Cancer Incidence and Mortality by Socioeconomic Level in the State of São Paulo, Brazil 2001-2017,” Endocrine Practice. DOI: 10.1016/j.eprac.2023.07.028.

Comments from RFAMD Editorial

In light of the compelling research published in Endocrine Practice, it appears that for certain cases of thyroid cancer, especially those detected during widespread screenings in affluent areas, less invasive approaches like thyroid ablation or vigilant observation may indeed be the more judicious courses of action. The conventional wisdom of aggressive treatment, such as surgery, is being challenged, suggesting that the scalpel may sometimes be more detrimental than the disease itself. 

This study not only calls for a more measured approach to thyroid cancer treatment but also raises questions about the current impetus for extensive screening. With the specter of overdiagnosis looming large, one has to ponder over the delicate balance between vigilance and overmedicalization. It’s imperative to consider whose financial interests are served by the proliferation of screenings—whether it’s the well-being of patients or the bottom lines of medical industries. As we navigate these complex decisions, the medical community must calibrate its protocols, prioritizing the long-term health and quality of life of those it aims to protect.

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