Diagnosis Disparities in Minorities Study

Results from one study show that despite a lower overall rate of thyroid cancer, African-Americans are generally diagnosed with a higher grade of cancer than in Caucasian populations.

Other studies have been published indicating economic issues chiefly underlie the differences in cancer stage upon diagnosis.

Lower levels of access to medical care due to economic constraints, or the inability to take time off from work have been linked to a longer time between the first symptoms of cancer and the beginning of cancer treatment.

The figure shows the thyroid cancer incidence rates by race and ethnicity for the US male and female in 2007. The thyroid cancer incidence rates are per 100, 000 US population and are age-adjusted to the 2000 US Standard Population 

Results from the study show that African Americans had double the rate of anaplastic thyroid cancer, an advanced and aggressive stage of thyroid cancer, when compared to Caucasian thyroid cancer patients.  African American patients were also twice as likely as Caucasian patients to have tumors larger than four centimeters.

Ask your doctor about screening tests for Thyroid Cancer.

The study used the National Cancer Institute’s database to look at data for the years 1992-2006, tracking five year survival rates of thyroid cancer patients in 17 states. Study data examined the cases of 26,902 patients diagnosed with thyroid cancer during that time.

“We think that the mortality rate is probably due to an access to care issues,” said Christopher Hollenbeak, PhD and lead study author.

“African-Americans were more likely to present with tumors larger than four centimeters, which implies that the tumors sat there and grew a lot longer,” he said.

Papillary and follicular cancer are the most common forms, and usually diagnosed in susceptible populations such as Caucasian or Asian groups. Complete treatment success for papillary and follicular thyroid cancers is close to 90 percent.

Anaplastic thyroid cancers, on the other hand, which were shown to be more commonly diagnosed in African American patients with thyroid cancer, can be fatal much more frequently.

One surgeon interviewed agreed that the difference could be amount of time elapsed from the cancer developing, to being treated. If caught early thyroid cancer treatment usually involves a small surgery, with some patients needing to take a small amount of radioactive iodine to completely destroy the cancer.

"The prevailing theory today is that anaplastic is thyroid cancer that goes haywire from not being treated,” said David Goldberg, MD, co-author of the study and currently a professor at Penn State.

The study was published in the journal Ethnicity & Disease. Authors denied any financial conflict of interest arising from the publication of their results.

Pediatric Thyroid Cancer Prognosis

Whereas the degree of invasion and metastases corresponds to prognosis in adults, this relationship is not seen in the pediatric population. In fact, the presence of lymph nodes does not affect the prognosis in children and adolescents. The reason for this is multifactorial and can be attributed to an overwhelming majority of well-differentiated cancers, low incidence of bone metastasis, and excellent response to RAI.

• Bone metastasis also has a low incidence in childhood thyroid cancers, occurring in less then 5% of patients.
• Individuals with radiation-induced thyroid cancer are at an increased risk for additional cancer later in life.

Pediatric patients have higher local and distant recurrence rates than adults, but they tend to respond rapidly to therapy. The prognosis is excellent in children, with mortality rates of less than 10%.

The overall 20-year survival rate is 92-100%.

Some studies report young age as the major determinant of recurrence in pediatric-differentiated thyroid carcinoma, which suggests a difference in tumor biology.

Rearrangements in the ret protooncogene have been observed in those exposed to radiation, with a reported ret rearrangement rate between 50 and 70%. Williams et al studied Chernobyl-induced thyroid tumor behavior and found that thyroid tumors associated with the ret and PTC3 oncogenes were more aggressive, faster growing, and less differentiated. Thyroid tumors with the ret/PTC1 oncogene had more benign characteristics and were slower growing.

Author: Mark E Gerber, MD, FACS, FAAP  Clinical Assistant Professor of Otolaryngology, University of Chicago, Pritzker School of Medicine; Section Head, Pediatric Otolaryngology-Head and Neck Surgery, NorthShore University HealthSystem  

Co-Author: Brian Kip Reilly, MD  Assistant Professor of Otolaryngology and Pediatrics, Department of Otolaryngology, Children's National Medical Center, George Washington University School of Medicine 

Thyroid Cancer Prognosis by Type and Stage

Survival rates are often used by doctors as a standard way of discussing a person's prognosis (outlook). Some patients with cancer may want to know the survival statistics for people in similar situations, while others may not find the numbers helpful, or may even not want to know them. Whether or not you want to read about the survival statistics below for thyroid cancer is up to you.

The 5-year survival rate refers to the percentage of patients who live at least 5 years after their cancer is diagnosed. Of course, many people live much longer than 5 years (and many are cured).

Five-year relative survival rates assume that some people will die of other causes and compare the observed survival with that expected for people without the cancer. This is a more accurate way to describe the prognosis for patients with a particular type and stage of cancer.

In order to get 5-year survival rates, doctors have to look at people who were treated at least 5 years ago. Improvements in treatment since then may result in a more favorable outlook for people now being diagnosed with thyroid cancer.

Survival rates are often based on previous outcomes of large numbers of people who had the disease, but they cannot predict what will happen in any particular person's case. Many other factors may affect a person's outlook, such as their age and general health. Your doctor can tell you how the numbers below may apply to you, as he or she is familiar with the aspects of your particular situation.

The following survival statistics come from the AJCC Cancer Staging Manual (7th ed).

Papillary thyroid cancer 5-year survival rate*
Stage I — 100%
Stage II — 100%
Stage III — 93%
Stage IV— 51%

*based on patients diagnosed 1998 to 1999

Follicular thyroid cancer 5-year survival rate*
Stage I — 100%
Stage II — 100%
Stage III — 71%
Stage IV— 50%

*based on patients diagnosed 1998 to 1999

Note: All the stage III and IV patients with follicular or papillary thyroid cancer are, by definition, over 45 years old.

Medullary thyroid cancer 5-year survival rate**
Stage I — 100%
Stage II — 98%
Stage III — 81%
Stage IV— 28%

**based on patients diagnosed between 1985 and 1991

Anaplastic Thyroid Cancer

The five-year relative survival rate for anaplastic (undifferentiated) carcinomas, all of which are considered stage IV, is around 7 percent (based on patients diagnosed between 1985 and 1991).

Scientists Explore How Thyroid Cancer Metastasizes

Distant metastases of thyroid cancer can dramatically reduce a patient's likelihood of survival, which is one reason why a scientist at the Ohio State University College of Medicine recently reviewed the current clinical understanding of how thyroid carcinoma cells migrate.

Dr. Matthew Ringel, who also hails from the Arthur G. James Comprehensive Cancer Center, stated that a number of factors can influence the metastasis of thyroid cancer, but that the disease appears to be able to spread at nearly any stage. Ringel's review, which appeared in the journal Thyroid, traced the study of metastasis back to 1889, when English pathologist Stephen Paget described cancer migration using a "seed and soil" model.

Today, this analogy is still widely used, according to a review published in the journal Clinical and Experimental Medicine. That said, in the past century, researchers have added significantly to the collective knowledge about how thyroid cancer spreads. Ringel noted that the migration of thyroid tumor cells to other parts of the body can be thought of in terms of short dormancy or long dormancy.

Short-dormant metastases involve the mutation of thyroid cancer epithelial cells into those that can grow into a number of different cell types. These cells escape into the bloodstream, stick in different organ systems and begin growing almost immediately.  The study's author noted that short-dormant metastatic cells tend to be organ-specific. For instance, while medullary thyroid cancer often metastasizes in the liver and bones, papillary thyroid cancer usually migrates to the lungs or brain, he wrote.

By contrast, long dormancy is a more recently observed phenomenon. Ringel stated that once embedded in a distant organ system, long-dormant thyroid cancer cells may wait for months or years before rapidly multiplying, due to either genetic variations, immune activity or the cellular micro environment.  The endocrinologist added that different varieties of the disease tend to be short- or long-dormant.

He specified that anaplastic, invasive papillary and invasive follicular thyroid cancers often spread quickly, while metastases of well-differentiated forms of the condition may experience long periods of dormancy.

SOURCE: endocrineweb

Last updated on 05/24/2011

First published on 05/23/2011

VIDEO: Understanding The Scope Of Thyroid Cancer

Dr. Mark Urken talks about the increasing incidence of thyroid cancer in the United States and the importance of the accurate assessment of the nodules so that the appropriate procedure will be performed. He also covers how the scope of the procedure may change if other structures are involved and how having the skill to deal with these problems is vital to a positive outcome. 

Source http://www.headneckandthyroid.com

Understanding Prognosis and Cancer Statistics

Patients and their loved ones face many uncertainties when dealing with cancer. It is natural for anyone facing cancer to be concerned about what the future holds. Understanding the nature of cancer and what to expect can help patients and their loved ones plan treatment, anticipate lifestyle changes, and make quality of life and financial decisions. Cancer patients frequently ask their physicians or search on their own for statistics to answer the question:

"What is my prognosis?"

Prognosis of cancer patients - the prediction of the future course and outcome of a cancer and an indication of the likelihood of recovery from that cancer. The doctor may speak of a favorable prognosis, if the cancer is expected to respond well to treatment, or an unfavorable prognosis, if the cancer is difficult to achieve cancer control. However, prediction is a prediction. When Oncologists discuss a cancer patient's prognosis, they are attempting to project what is likely to occur for that individual patient based on available data on record and past experience with patients in very similar circumstances.

Many factors affect a person’s prognosis. Some of the most important are the type and location of the cancer, the stage of the disease (the extent to which the cancer has metastasized, or spread if at all), and its grade (how abnormal the cancer cells look and how quickly the cancer is likely to grow and spread). In addition, for hematologic cancers (cancers of the blood or bone marrow) such as leukemias and lymphomas, the presence of chromosomal abnormalities and abnormalities in the patient’s complete blood count (CBC) can affect a person’s prognosis. Other factors that may also affect the prognosis include the person’s age, general health, and response to treatment.

You must remember and be very clear because we cannot stress this enough; when doctors discuss a person’s prognosis, they carefully consider all factors that could affect that person’s disease and treatment and then try to predict what might happen. The doctor bases the prognosis on information researchers have collected over many years about hundreds or even thousands of people with cancer but one can predict with 100% certainty what will happen in your care.

Whenever possible, the doctor uses statistics based on groups of people whose situations are most similar to that of an individual patient. Several types of statistics might be used to discuss prognosis. Some commonly used statistics are described below:

• Survival rate indicates the percentage of people with a certain type and stage of cancer who survive for a specific period of time after their diagnosis. For example, 55 out of 100 people with a certain type of cancer will live for at least 5 years, and the other 45 people will not. Survival statistics may further categorize the people who die by cause of death because some will die from unrelated causes. For example, of the 45 people mentioned above, 35 may die from their cancer and 10 may die from other causes.

• The 5-year survival rate indicates the percentage of people who are alive 5 years after their cancer diagnosis, whether they have few or no signs or symptoms of cancer, are free of disease, or are having treatment. Five-year survival rates are used as a standard way of discussing prognosis as well as a way to compare the value of one treatment with another. It does not mean that a patient can expect to live for only 5 years after treatment or that there are no cures for cancer.

• Disease-free or recurrence-free survival rates represent how long one survives free of the disease, rather than until death.

Because survival rates are based on large groups of people, they cannot be used to predict what will happen to a particular patient. No two patients are exactly alike, and treatment and responses to treatment vary greatly.

The doctor may speak of a favorable prognosis if the cancer is likely to respond well to treatment. The prognosis may be unfavorable if the cancer is likely to be difficult to control. It is important to keep in mind, however, that a prognosis is only a prediction. Again, doctors cannot be absolutely certain about the outcome for a particular patient.

Is it helpful to know the prognosis?

Cancer patients and their loved ones face many unknowns. Understanding cancer and what to expect can help patients and their loved ones plan treatment, think about lifestyle changes, and make decisions about their quality of life and finances. Many people with cancer want to know their prognosis. They find it easier to cope when they know the statistics. They may ask their doctor or search for statistics such as survival rates on their own. Other people find statistical information confusing and frightening, and they think it is too impersonal to be of use to them.

The doctor who is most familiar with a patient’s situation is in the best position to discuss the prognosis and to explain what the statistics may mean for that person. At the same time, it is important to understand that even the doctor cannot tell exactly what to expect. In fact, a person’s prognosis may change if the cancer progresses or if treatment is successful.

Seeking information about the prognosis is a personal decision. It is up to each patient to decide how much information he or she wants and how to deal with it.

THYROID CANCER SURVIVAL RATES

Male vs Female Mortality Rates Tables

Survival rates indicate the percentage of people who survive the disease for a specific period of time after their diagnosis. In most cases, statistics refer to the five-year survival rate. The five-year survival rate is the percentage of people who are alive five years after diagnosis, whether they have few or no signs or symptoms of cancer, are free of disease, or are receiving treatment. 

Survival rates are based on large groups of people; they cannot be used to predict what will happen to a particular patient. No two patients are exactly alike, and thyroid cancer treatment and responses to treatment vary greatly.

Thyroid Cancer Prognosis: Survival Rates

Survival rates can be calculated by different methods for different purposes. The thyroid cancer survival rates presented here are based on the relative survival rate. The survival rate measures the survival of thyroid cancer patients in comparison to the general population to estimate the effect of cancer.

The overall five-year relative thyroid cancer survival rate from 1995-2001 was 96.6 percent.

The five-year relative thyroid cancer survival rates by race and sex were:

• 94.4 percent for Caucasian men.
• 97.7 percent for Caucasian women.
• 89.2 percent for African American men.
• 95.4 percent for African American women.

Impact of the Stage in Thyroid Cancer Prognosis

The stage of thyroid cancer plays a role in the thyroid cancer prognosis. Based on historical data:

• 58 percent of thyroid cancer cases are diagnosed while the cancer is still confined to the primary site (localized stage).

• 35 percent of thyroid cancer cases are diagnosed after the cancer has spread to regional lymph nodes or directly beyond the primary site (regional stage).

• 5 percent of thyroid cancer cases are diagnosed after the cancer has already metastasized (distant stage).

• 2 percent of thyroid cancer cases had staging information that was unknown.

The corresponding five-year relative thyroid cancer survival rates were:

• 99.5 percent for localized
• 96.4 percent for regional
• 60.0 percent for distant
• 85.4 percent for unstaged.

Final Thoughts on Thyroid Cancer Prognosis

Cancer patients and their loved ones face many unknowns. While some people find that it is easier to cope when they know the statistics, other people find statistical information confusing and frightening, and they think it is too impersonal to be of use to them. 

The doctor who is most familiar with a patient's situation is in the best position to discuss the thyroid cancer prognosis, and to explain what the statistics concerning thyroid cancer may mean for that person. At the same time, it is important to understand that even the doctor cannot tell the patient exactly what to expect because a person's prognosis may change if the cancer progresses, or if treatment is successful. 

Seeking information about the thyroid cancer prognosis is a personal decision. It is up to each patient to decide how much information he or she wants to know and how to deal with it.

THYROID CANCER PROGNOSIS

People facing thyroid cancer are naturally concerned about what the future holds.Thyroid cancer is a serious disease in which cancer cells first develop in the thyroid gland.Understanding thyroid cancer and what to expect can help patients and their loved ones:

Plan the course of treatment: surgery, radiation therapy, and chemotherapy are some of the options for treating thyroid cancer.

Think about lifestyle changes

Make decisions about their quality of life, finances and more (such as healthcare proxy, healthcare directives, children's guardianship, power of attorney or last will and testament.

Many people with thyroid cancer want to know their thyroid cancer prognosis. They may ask their doctor or search for thyroid cancer statistics on their own. An estimated 30,180 Americans have been newly diagnosed with thyroid cancer every year since 2006 and that information alone may create more questions than answers.

What Is a Thyroid Cancer Prognosis?

A prognosis is a medical opinion as to the likely course and outcome of a disease. In other words, the prognosis is the chance that a patient will recover or have a recurrence (return of the cancer). There are many factors that can affect a person's prognosis, which include:

• The type and location of the cancer.
• The stage of the disease (the extent to which the cancer has metastasized, or spread).
• Its grade (how abnormal the cancer cells look, and how quickly the cancer is likely to grow and spread)
• The person's age, general health, and response to treatment.

When doctors consider a person's prognosis, they carefully examine all of the factors that could affect that person's disease and treatment, and then try to predict what might happen.

The doctor bases the thyroid cancer prognosis on information researchers have collected over many years about hundreds, or even thousands, of people with cancer. When possible, the doctor will use statistics based on groups of people whose situations are most similar to that of an individual patient.

The doctor may speak of a favorable thyroid cancer prognosis if the cancer is likely to respond well to treatment. The thyroid cancer prognosis may be unfavorable if the cancer is likely to be difficult to control. However, it is important to remember that a prognosis is only a prediction -- the doctor cannot be absolutely certain about the outcome for a particular patient.

Factors Influencing a Thyroid Cancer Prognosis

The thyroid cancer prognosis will depend on:

(1)The stage of thyroid cancer (see Thyroid Cancer Staging).

(2)The type of thyroid cancer cells and how tthey look under a microscope.

(3)The patient's age and general health.

The prognosis is better for patients younger than 40 years of age who have cancer that has not spread beyond the thyroid.