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If it's cancer, we must operate - or not, according to study - p2

A friend of ours often tells us that technology is not always our friend. In medicine, technology -- pardon the pun -- cuts both ways. While diagnostics have greatly improved patient care and outcomes, the new tools may also give us information much sooner than we really should have it.

Pregnancy tests, for example, are so sensitive now that women can get the good news within days of conception. According to Mayo Clinic, during the first 20 weeks of pregnancy, around 10 percent to 20 percent of known pregnancies will end in miscarriage. That does not take into account the number of women who miscarry without ever realizing they are pregnant. Perhaps those extra-sensitive tests, then, give hopeful women more heartache than joy.

Early detection of cancer is another situation in which patients may know too much too soon. As we discussed in our Feb. 26 post, there are cancers that never cause symptoms, much less prove fatal. Faced with even the remote chance of what our friend calls "capital-C cancer," chances are good a patient will opt for aggressive treatment.

With thyroid cancer, the aggressive treatment of choice is removal of the gland. The procedure is not recommended, but 85 percent of patients diagnosed with thyroid cancer have the surgery. Because the thyroid plays a central role in regulating our metabolism, the patient will need to replace the hormones through daily medication for the rest of his life. Hormone therapy, however, comes with its own set of problems. The cure may be worse than the disease for patients with the low-risk type of cancer.

A cancer specialist responds to the survey with a warning. The most common type of thyroid cancer has an exceptionally high survival rate, more than 90 percent. Many patients, the specialist says, are more likely to die naturally with a papillary thyroid cancer nodule than from it.

It has taken decades to condition patients with early-stage prostate cancer that watchful waiting is a sound approach. Convincing thyroid cancer patients of the same may be more challenging. Still, as the cancer expert says, patients "can no longer assume" that a cancer diagnosis means that treatment is necessary.

And yet, doctors may not want to risk an accusation of negligence for just making the suggestion.

Source: SFGate, "Thyroid cancer overdiagnosed, many researchers say," Victoria Colliver, March 4, 2014

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