Japanese scientists analyze use of surgeries for papillary thyroid cancer

A group of scientists from Kuma Hospital, Japan, recently published a report analyzing the frequency and necessity of two common treatments for papillary thyroid cancer - the thyroidectomy and lymph node dissection.

The study, published in the Journal of Thyroid Research, asserts that thyroidectomies are somewhat overused in the typical American medical response to the disease, while partial thyroidectomy with lymph node dissection is routinely prescribed in Japan.

Papillary thyroid cancer is the most common thyroid carcinoma in the U.S., accounting for an estimated 70 percent of all diagnoses of thyroid cancer, if not more, the Columbia University Medical Center states.

In Japan, the incidence of papillary carcinomas is even higher. Approximately 93 percent of thyroid cancer diagnoses are papillary in nature, according to a survey conducted by the Japanese Society of Thyroid Surgeons.

The authors of the new study suggest that this higher incidence could be the result of iodine deficiencies in the Japanese diet. Whatever the cause, surgeons Yasuhiro Ito and Akira Miyauchi write that the use of total thyroidectomies to treat the disease is not merited as often as it is performed in the U.S.

Papillary carcinoma is one of the mildest forms of thyroid cancer. With treatment, the estimated 10-year survival rate is between 80 and 90 percent.

Because of this fact, the Japanese pair recommends that thyroidectomy not be performed as a matter of course. Instead, it should be done only after careful consideration of a patient's treatment options, which extend beyond merely removing the whole gland, they note.

Another treatment for papillary thyroid cancer, one which is more common in Japan, is a partial thyroidectomy with extensive lymph node dissection. Lymph nodes are the organ in which thyroid cancer is most likely to recur, the researchers state.

Compared to full thyroidectomy, this procedure is very common in Japan. The study's authors explain that this is due both to legal restrictions on full thyroid removal and to the perceived cost-effectiveness of lymph node dissection.

They conclude that full thyroidectomy should not be performed as a matter of course, since papillary carcinomas may be detected and removed with less extensive surgery and chemotherapy. They also recommend that, even when partial thyroidectomy and lymph node removal seems in order, each case should be considered on an individual basis.

In the U.S., nearly 45,000 people are diagnosed with thyroid cancer every year, according to the National Cancer Institute.
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