I listened to an archived podcast of Brown University Medical School’s Radiology dept. chief Dr. John J Cronan on ReachMD radio this morning and was pleasantly surprised to hear yet another doctor suggesting that cancer is something our bodies can, and do, defeat more often than we realize.
He was discussing a subtype of cancer called Papillary cancer. There are a few other kinds of thyroid cancer but this is far and away the most common. So common, in fact, that nearly 4 out of 10 adults walking around probably have it.
In an autopsy study that sliced people’s thyroids into 2mm sections, 36% men and women who died from other causes, mostly trauma, were found to have tiny pieces of it growing in their thyroid glands. If the glands were sliced even smaller, it’s likely the percentage of people with cancer cells would have been higher, according to Dr. Cronan.
Should all papillary cancers be removed?
Right now, most surgeons would recommend that anyone with even a tiny papillary cancer in their thyroid have the entire gland removed and take hormone replacement for the rest of their life. But Dr. Cronan argues that we need to rethink this practice from the ground up. When we doctors send our patients off for thyroid ultrasounds for reasons other than having felt a suspicious nodule under our fingertips, very often the ultrasound shows calcifications that look suspicious for cancer. Then, we put the patient through a biopsy, and, very often, the pathologist finds 1-2mm sized nests of papillary cancerous cells that are too small to be felt on exam. Dr. Cronan suggests, rather than taking out a person’s thyroid, maybe we should let these nests of cancerous cells alone.
He’s not the first to think this way. Dr. Cronan cited a Japanese surgeon who studied 160 people with this kind of thyroid cancer. In that study, half of the people decided not to have their thyroid removed, while the other half had it removed and were given thyroid hormone replacement. Five years later, the people who had the surgery were five times more likely to have developed new cancers in the lymph nodes of their neck than the people who just let the cancer sit there.
This surprising finding makes me wonder if having surgery, or being the kind of person that choses surgery over watchful waiting, disrupts the immune system enough to increase your risk of cancer. (The other variable is that the people who had surgery also were given thyroid hormone replacement, however, that is not known to cause thyroid cancer.)
In my career, I have found two people with this kind of thyroid cancer and sent them off to surgery to have their thyroids removed. I still am in touch with one, now nearly ten years later, and he’s fine taking his hormone replacement daily. I think we did the right thing for him; I could feel his cancer with my fingers, it was that big. But this kind of basic investigative research makes me question the notion of cancer as a death sentence.