Thyroid cancer overdiagnosis and overtreatment: a cross- sectional study at a thyroid cancer referral center in Ecuador
Abstract Background In contrast to the rapid increase in thyroid cancer incidence, the mortality has remained low and stable over the last decades. In Ecuador, however, thyroid cancer mortality has increased. The objective of this study is to determine possible drivers of high rates of thyroid cance...
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doaj-8a6a9d67ccc543a48487b22070d21b3e2021-01-10T12:59:35ZengBMCBMC Cancer1471-24072021-01-0121111010.1186/s12885-020-07735-yThyroid cancer overdiagnosis and overtreatment: a cross- sectional study at a thyroid cancer referral center in EcuadorPaola Solis-Pazmino0Jorge Salazar-Vega1Eddy Lincango-Naranjo2Cristhian Garcia3Gabriela Jaramillo Koupermann4Esteban Ortiz-Prado5Tannya Ledesma6Tatiana Rojas7Benjamin Alvarado-Mafla8Cesar Carcamo9Oscar J. Ponce10Juan P. Brito11Otolaryngology Head and Neck Department, Stanford UniversityCaTaLiNa (Thyroid Cancer in LatinAmerica)Knowledge and Evaluation Research Unit, Mayo ClinicCaTaLiNa (Thyroid Cancer in LatinAmerica)CaTaLiNa (Thyroid Cancer in LatinAmerica)One Health Research Group, Universidad de las Americas, Quito, EcuadorCaTaLiNa (Thyroid Cancer in LatinAmerica)CaTaLiNa (Thyroid Cancer in LatinAmerica)CaTaLiNa (Thyroid Cancer in LatinAmerica)School of Public Health and Administration, Universidad Peruana Cayetano HerediaKnowledge and Evaluation Research Unit, Mayo ClinicKnowledge and Evaluation Research Unit, Mayo ClinicAbstract Background In contrast to the rapid increase in thyroid cancer incidence, the mortality has remained low and stable over the last decades. In Ecuador, however, thyroid cancer mortality has increased. The objective of this study is to determine possible drivers of high rates of thyroid cancer mortality, through a cross-sectional analysis of all patients attending a thyroid cancer referral center in Ecuador. Methods From June 2014 to December 2017, a cross-sectional study was conducted at the Hospital de Especialidades Eugenio Espejo, a regional reference public hospital for endocrine neoplasia in adults in Quito, Ecuador. We identified the mechanism of detection, histopathology and treatment modalities from a patient interview and review of clinical records. Results Among 452 patients, 74.8% were young adults and 94.2% (426) were female. 13.7% had a family history of thyroid cancer, and patients’ median tumor size was 2 cm. The incidental finding was 54.2% whereas 45.8% was non-incidental. Thyroid cancer histology reported that 93.3% had papillary thyroid cancer (PTC), 2.7% follicular, 1.5% Hurtle cells, 1.6% medullary, 0.7% poor differentiated, and 0.2% anaplastic carcinoma. The mean MACIS (metastasis, age, completeness, invasion, and size) score was 4.95 (CI 4.15–5.95) with 76.2% of the thyroid cancer patients having MACIS score less than or equal to 6. The very low and low risk of recurrence was 18.1% (79) and 62% (271) respectively. An analysis of 319 patients with non-metastatic thyroid cancer showed that 10.7% (34) of patients had surgical complications. Moreover, around 62.5% (80 from 128 patients with thyroglobulin laboratory results) of TC patients had a stimulated-thyroglobulin value equal or higher than 2 ng/ml. Overall, a poor surgical outcome was present in 35.1% (112) patients. Out of 436 patients with differentiated thyroid carcinoma, 86% (375) received radioactive iodine. Conclusion Thyroid cancer histological characteristics and method of diagnosis are like those described in other reports without any evidence of the high frequency of aggressive thyroid cancer histology. However, we observed evidence of overtreatment and poor surgical outcomes that demand additional studies to understand their association with thyroid cancer mortality in Ecuador.https://doi.org/10.1186/s12885-020-07735-yThyroid CancerHistopathologySurgicalOutcomeEcuadorLatin-America |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Paola Solis-Pazmino Jorge Salazar-Vega Eddy Lincango-Naranjo Cristhian Garcia Gabriela Jaramillo Koupermann Esteban Ortiz-Prado Tannya Ledesma Tatiana Rojas Benjamin Alvarado-Mafla Cesar Carcamo Oscar J. Ponce Juan P. Brito |
spellingShingle |
Paola Solis-Pazmino Jorge Salazar-Vega Eddy Lincango-Naranjo Cristhian Garcia Gabriela Jaramillo Koupermann Esteban Ortiz-Prado Tannya Ledesma Tatiana Rojas Benjamin Alvarado-Mafla Cesar Carcamo Oscar J. Ponce Juan P. Brito Thyroid cancer overdiagnosis and overtreatment: a cross- sectional study at a thyroid cancer referral center in Ecuador BMC Cancer Thyroid Cancer Histopathology Surgical Outcome Ecuador Latin-America |
author_facet |
Paola Solis-Pazmino Jorge Salazar-Vega Eddy Lincango-Naranjo Cristhian Garcia Gabriela Jaramillo Koupermann Esteban Ortiz-Prado Tannya Ledesma Tatiana Rojas Benjamin Alvarado-Mafla Cesar Carcamo Oscar J. Ponce Juan P. Brito |
author_sort |
Paola Solis-Pazmino |
title |
Thyroid cancer overdiagnosis and overtreatment: a cross- sectional study at a thyroid cancer referral center in Ecuador |
title_short |
Thyroid cancer overdiagnosis and overtreatment: a cross- sectional study at a thyroid cancer referral center in Ecuador |
title_full |
Thyroid cancer overdiagnosis and overtreatment: a cross- sectional study at a thyroid cancer referral center in Ecuador |
title_fullStr |
Thyroid cancer overdiagnosis and overtreatment: a cross- sectional study at a thyroid cancer referral center in Ecuador |
title_full_unstemmed |
Thyroid cancer overdiagnosis and overtreatment: a cross- sectional study at a thyroid cancer referral center in Ecuador |
title_sort |
thyroid cancer overdiagnosis and overtreatment: a cross- sectional study at a thyroid cancer referral center in ecuador |
publisher |
BMC |
series |
BMC Cancer |
issn |
1471-2407 |
publishDate |
2021-01-01 |
description |
Abstract Background In contrast to the rapid increase in thyroid cancer incidence, the mortality has remained low and stable over the last decades. In Ecuador, however, thyroid cancer mortality has increased. The objective of this study is to determine possible drivers of high rates of thyroid cancer mortality, through a cross-sectional analysis of all patients attending a thyroid cancer referral center in Ecuador. Methods From June 2014 to December 2017, a cross-sectional study was conducted at the Hospital de Especialidades Eugenio Espejo, a regional reference public hospital for endocrine neoplasia in adults in Quito, Ecuador. We identified the mechanism of detection, histopathology and treatment modalities from a patient interview and review of clinical records. Results Among 452 patients, 74.8% were young adults and 94.2% (426) were female. 13.7% had a family history of thyroid cancer, and patients’ median tumor size was 2 cm. The incidental finding was 54.2% whereas 45.8% was non-incidental. Thyroid cancer histology reported that 93.3% had papillary thyroid cancer (PTC), 2.7% follicular, 1.5% Hurtle cells, 1.6% medullary, 0.7% poor differentiated, and 0.2% anaplastic carcinoma. The mean MACIS (metastasis, age, completeness, invasion, and size) score was 4.95 (CI 4.15–5.95) with 76.2% of the thyroid cancer patients having MACIS score less than or equal to 6. The very low and low risk of recurrence was 18.1% (79) and 62% (271) respectively. An analysis of 319 patients with non-metastatic thyroid cancer showed that 10.7% (34) of patients had surgical complications. Moreover, around 62.5% (80 from 128 patients with thyroglobulin laboratory results) of TC patients had a stimulated-thyroglobulin value equal or higher than 2 ng/ml. Overall, a poor surgical outcome was present in 35.1% (112) patients. Out of 436 patients with differentiated thyroid carcinoma, 86% (375) received radioactive iodine. Conclusion Thyroid cancer histological characteristics and method of diagnosis are like those described in other reports without any evidence of the high frequency of aggressive thyroid cancer histology. However, we observed evidence of overtreatment and poor surgical outcomes that demand additional studies to understand their association with thyroid cancer mortality in Ecuador. |
topic |
Thyroid Cancer Histopathology Surgical Outcome Ecuador Latin-America |
url |
https://doi.org/10.1186/s12885-020-07735-y |
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