Why are thyroid cancer rates higher than they used to be?

The thyroid is a butterfly-shaped gland located in the front of your neck. Although it’s small, it serves a host of vital functions. As a key part of the endocrine system, the thyroid produces, stores, and releases hormones affecting every organ in our bodies. It helps control metabolism and body temperature, as well as heart and brain function.

The thyroid is also the site of a common form of cancer. Thyroid cancer, an overgrowth of potentially harmful cells, begins in the thyroid gland and can spread to other parts of the body.

More than 44,000 people in the United States are diagnosed with thyroid cancer each year, according to the National Cancer Institute. and more than 2,100 die of the disease. Although both men and women are susceptible, women are three times more likely to develop it.

Thyroid cancer rates increased significantly between 1980 and 2013 and have remained relatively steady since then. Here’s what to know about why rates have changed over time, how the disease is detected, and what treatment options are available.

Are you at risk for thyroid cancer?

Although thyroid cancer can affect anyone, some people are at a higher risk. These include:

• Women
• People between 25 and 65 years old
• Asian people and Pacific Islanders
• Those with a family history of thyroid disease
• People with certain health issues, including a goiter (enlarged thyroid) or specific genetic conditions such as Cowden syndrome
• People who have been exposed to radiation—especially to the head or neck during childhood

Detecting the disease

Thyroid cancer screenings aren’t typically done as part of physical exams. In fact, the U.S. Preventive Services Task Force (USPSTF) recommends against routine screenings with ultrasound technology and physical neck examinations in adults without symptoms.

"There is pretty good literature to say that we don't have good screening tests that are cost-effective or medically beneficial," says Kimberly Vanderveen, MD, a board-certified surgeon in Denver, Colorado. “Most of the time, thyroid cancer doesn't have any warning signs or symptoms. It's often found as an accident."

It's not uncommon for healthcare providers (HCPs) to detect early cases of thyroid cancer during ultrasound tests for unrelated issues, like narrowing of carotid arteries in the neck or an overactive parathyroid gland.

While early stages of thyroid cancer are typically symptomless, more advanced forms of the disease may present with some signs and symptoms. Make an appointment with your HCP if you notice:

• A lump or swelling in the neck
• Trouble swallowing
• Constant coughing, not due to a cold or flu
• Pain in the front of the neck

"By the time people have symptoms, usually thyroid nodules are slightly more advanced," says Dr. Vanderveen.

Once a lump is found in the thyroid, your HCP will use imaging tests, like an ultrasound, to gather information about the size, color, and location of the mass. An ultrasound cannot determine whether a lump is cancerous. For that, a biopsy is performed. It uses a thin needle to remove a tissue sample to check for cancer.

"Approximately 5 percent of thyroid nodules are cancerous, but another 10 percent or so might have some suspicious features on biopsy," Vanderveen says.

Why thyroid cancer rates rose

Though they’ve dropped in recent years, thyroid cancer diagnoses increased greatly between the 1980s and the 2010s. One big reason? Many experts believe the disease was overdiagnosed during that period. That means cases were discovered that would never have caused a problem or resulted in death, even if they went untreated.

Vanderveen suggests that more advanced testing for other conditions contributed to this uptick. Doing medical imaging for unrelated conditions can lead to “finding some cancers that are dormant and may never have affected people,” she says.

Now that HCPs are more aware of the potential for overdiagnosis, thyroid cancer rates have become more stable.

How HCPs treat thyroid cancer

The vast majority of thyroid cancer cases are curable, especially if they haven’t spread to distant areas in your body. Treatment depends largely on the type and stage of the cancer. In some cases, active surveillance is recommended. That’s when HCPs monitor the cancer’s progress using ultrasounds.

Most of the time, however, surgery is the first step in treatment.

"At this point in time, the standard of care in the United States is to remove all thyroid cancers, but we have gotten less aggressive in our approaches," Vanderveen notes.

Depending on the severity, a surgeon will either remove a portion of the thyroid or the entire organ. During surgery, if lymph nodes on the neck appear to have been affected, they will also be removed for biopsy. Although this procedure is fairly safe, there are some risks. Bleeding is among the most common.

Following surgery to remove the entire thyroid, patients will be prescribed a life-long medication regimen to replace the hormones the thyroid previously produced. In addition to helping the body maintain its normal metabolism, hormone replacement therapy can also put a stop to the growth of any remaining cancer cells. When only a portion of the thyroid is removed, hormone medication may not be necessary.

In certain cases, thyroid cancer patients may undergo radiation therapy, chemotherapy, targeted drug therapies, or radioactive iodine treatment—a one-time oral medication that destroys remaining thyroid tissue.

Your team of HCPs—a combination of surgeons, oncologists and endocrinologists—will help determine the best course of treatment for you or your loved one.