Especially for women: Answers about thyroid cancer

September 26, 2018 Providence Health Team

Incidence of thyroid cancer is on the rise, and women have more than their share of cases.

Most thyroid cancers are very curable.

The main sign of thyroid cancer is a lump or mass on the neck.

The incidence rate of thyroid cancer has been growing and keeps rising rapidly — it’s the fastest-growing type of cancer in that regard. That’s why thyroid cancer management has become increasingly relevant, especially for women, says Shaghayegh  Aliabadi-Wahle, MD, an endocrine surgeon at Providence Cancer Institute – Oregon and  The Oregon Clinic.

“In 2017, the new thyroid cancer incidence was suggested to be around 59,000 individuals and we think around 42,000 of them are women,” Dr. Aliabadi-Wahle says, adding that the overall incidence of thyroid cancer for both genders is projected to increase to 183,000 by 2030. “Right now, thyroid cancer is the fifth-most prominent type of new cancer detected in women, behind breast, lung, colon and uterine cancer.”

Why has thyroid cancer become more common?

There are some hypotheses that try to explain the data, Dr. Aliabadi-Wahle says. One theory suggests that the increased prevalence is due to significant use of head and neck external beam radiation for childhood conditions as benign as acne and tonsilitis up until the 1960s. In fact, thyroid cancer incidence rates tripled between 1975 and 2012. However, despite those treatments having been largely abandoned, the incidence rate keeps rising.

“Some people suggest that in the United States that is due to increased detection of small tumors because we are using imaging more commonly,” she adds. “But when you zero in on the data it shows an increase in all tumor sizes, not just the smaller ones.”

The rise of thyroid cancer incidences takes a toll on our health care system. The research literature estimates that in 2013, the cost of thyroid cancer management was $1.6 billion, and by 2030 it’s projected to be about $3.5 billion. But despite the increase in cases and health care costs, there is one piece of good news: even though the incidence of thyroid cancer has increased, death rates have remained flat — meaning that the majority of cases are treatable.

“Ninety percent of thyroid cancers that are diagnosed are called well differentiated thyroid cancers and they are very non- aggressive, so it is very curable,” Dr. Aliabadi-Wahle says.

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What women should know about thyroid cancer

When it comes to the gender disparity, it’s important to note that the less aggressive kind of thyroid cancer is more common among women, while more aggressive cancer is more evenly distributed between men and women. There are also several risk factors common to both men and women.

Radiation exposure, particularly during childhood, is one of the more clearly defined environmental risk factors. Dr. Aliabadi-Wahle divides these into different categories: therapeutic radiation for a childhood disease, environmental exposure such as fallout from atomic weapons or nuclear power accidents, and, as previously mentioned, radiation treatment for common childhood ailments.

Another risk factor is family history, especially if a first-degree relative has thyroid cancer. In particular, there are hereditary syndromes that lead to an increased risk of thyroid cancer, such as familial polyposis and multiple endocrine neoplasia type 2.

Thyroid cancer risk also may increase with age, although for women, the incidence rate rises at the beginning of the reproductive years and peaks between the ages of 40 and 49; for men, it peaks between ages 60 and 69. While women have an earlier age of onset than men, the men tend to have a more aggressive disease at the time of diagnoses, Dr. Aliabadi-Wahle says. She adds that while the gender disparity with thyroid cancer has been well established, the cause of it has not, making it a prime area for future research.

One of the most difficult things about thyroid cancer is that most people show no symptoms. “A tumor can often be identified incidentally during an exam or imaging for an unrelated problem,” Dr. Aliabadi-Wahle says. “But when there is a symptom, it’s usually a nodule or mass in the neck.” However, Dr. Aliabadi-Wahle points out that an estimated 90 percent of neck nodules are benign—and if they are cancerous, then 90 percent of those are easily treatable.

Women should also know that if they get their thyroid level checked during a blood test and it comes back normal, that doesn’t necessarily mean they are in the clear for thyroid cancer. Over- or underproduction of thyroid hormones is what Dr. Aliabadi-Wahle considers a functional thyroid disorder and that’s different from cancer. Ideally, a woman should have her physician conduct a physical check of her neck for any signs of odd bumps or lumps.

If there is a lump that causes concern for either you or your doctor, it’s very easy to evaluate. It often involves a blood test to make sure the nodule isn’t overproducing hormones, as well as an ultrasound to determine if a biopsy is needed. A biopsy is almost always done with a needle guided by ultrasound.

If a biopsy does reveal a cancer diagnosis, Dr. Aliabadi-Wahle says her goals as a surgeon are to remove the primary tumor as well as any disease in the area, such as in nearby lymph nodes; minimize the risk of recurrence; have a good follow-up strategy for her patients and, last but not least, minimize treatment-related morbidity.

“I tell my patients that my goal isn’t just to increase their number of days but to optimize their quality of life in any given day,” she says.

For the common well-differentiated cancer, treatment usually includes surgery, sometimes radiation and thyroid hormone replacement therapy. Surgery can typically be done on an outpatient basis or with just an overnight hospital stay. It takes a couple of weeks to return to work, if the job isn’t strenuous.

Dr. Aliabadi-Wahle wants to stress what a good prognosis this cancer usually has. “In the latest guidelines there’s even an option for active surveillance of really, really small cancers of less than 1 centimeter in appropriate patients who either can’t undergo surgery or choose not to. However, this means watching patients very carefully, and it’s not applicable to everyone.”

The main takeaway is that if you have spotted a lump in your neck, don’t hesitate to have your doctor look at it. “It’s fixable and it has such a good prognosis in 90 percent of patients,” Dr. Aliabadi-Wahle says. “If you’re going to have cancer this is a very optimistic kind of cancer to have.”

If you have questions about cancer or women’s health issues, find a health care provider in our physician directory. Subscribe to our blog and you’ll never miss a health update.

OR: Providence Cancer Institute

CA: Roy and Patricia Disney Family Cancer Center; John Wayne Cancer Institute; St. Jude Crosson Cancer Institute

WA: Providence Regional Cancer System; Providence Regional Cancer Center - Spokane; Swedish Cancer Institute; Kadlec Oncology Program; Pacific Medical Centers

MT: Montana Cancer Center at Providence St. Patrick Hospital and Providence St. Joseph Medical Center

AK: Providence Cancer Center

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This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.

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