International Women's Health Day: Thyroid cancer, new epidemic?

THIRUVANANTHAPURAM: Doctors and oncologists who are at a loss to explain the sharp increase in the number of thyroid cancer patients in Kerala have called for a detailed investigation to find out what triggers the alarming situation. They rule out background radiation and iodine deficiency as the reason; they also reject the theory propounded by researchers in Kentucky University that it is over-diagnosis, not actual incidence, that is reflected in the rising numbers. Figures provided by cancer registries in the state show that thyroid cancer has become the second most prevalent form of the disease among women in Kerala after breast cancer in a span of 30 years.

Doctors at RCC say that so far there are only two population-based cancer registries in the state, one in Thiruvananthapuram and the other in Kollam. Coinciding with the three-year report of Population-Based Cancer Registries, the Indian Council of Medical Research had come out with a study in 2009-11 that thyroid cancer followed breast cancer in the two PBCRs in Kollam and Thiruvananthapuram. This conclusion was made after analysing reports of 25 PBCRs in India. The same statistics was revealed yet again in 2012-14 coinciding with the findings of the PBCR.

As per Amrita Institute of Medical Science's cancer registry, 8,586 diagnosed thyroid cancers would require medical attention and services in a year in the state while there will be 2,862 newly-diagnosed female thyroid cancer patients every year in the coming decade. The registry data shows that 2,480 cases of thyroid cancers were reported in 2013-2014 of them 1,064 were newly- diagnosed ones. Dr. M. C. Kalavathy, assistant professor at the tumour registry at Regional Cancer Centre here, told DC that hormone-related cancers like breast, thyroid and ovarian were on the rise. One reason for the upsurge in thyroid cancer may be the change in lifestyle, she said.

Dr. P. K. Jabbar, professor and head of the department of endocrinology at Government Medical College, Thiruvananthapuram, says that as per statistics, there has been an increase in thyroid cancer over the years. "Out of 300 patients whom I saw at the OP clinic the other day, 20 per cent had come with thyroid nodules," he said. "But that does not mean that they all have cancer." Better diagnostic tools such as thyroid function test have helped early detection of thyroid cancer, he said. "But many patients have only neck pain or neck discomfort," said Dr. Jabbar.

Recently, two Malayali researchers in Kentucky University in US had revealed that over-diagnosis was causing a rise in thyroid cancer numbers in Kerala. Endocrinology experts say that people come to them after check-up without the doctors' recommendation. Dr. Arun Sasikumar, consultant at Hindlabs Diagnostic Centre of the public sector Hindustan Lifecare Ltd, told DC that there was no need to panic on the surge in thyroid cancer as out of 200 people complaining of thyroid issues, only two or three people will be affected by cancer.

The common symptoms of the disease include a lump or thyroid nodule in the neck, difficulties in swallowing, throat or neck pain, swollen lymph nodes in the neck and persistent cough and changes in the voice. Though thyroid cancer is mostly found in women, men also get it with the common type being papillary, followed by follicular carcinoma. "If thyroid cancer is detected at an early stage, 90 percent can be cured. The cause of thyroid cancer is unknown, but certain risk factors include a family history of goitre and certain hereditary syndromes," he said. "If detected fairly early, and the necessary follow-up is done, the person can expect to lead a normal life," added Dr. Jabbar. "This highlights the need of facilities for early detection and awareness of the disease."