The UFC publishes the figures for the overtreatment of thyroid cancer in France. Its ablation is still too systematic today, putting patients at unnecessary risk.
In France, there are around 40,000 thyroid ablations every year. ” It’s too much ! », Denounces Professor Martin Schlumberger, oncologist at the Gustave-Roussy Institute (94) in the columns of Que Choisir Santé. Indeed, in its last issue of October, UFC investigators publish the figures for overtreatment of thyroid cancer in France. And call on the public authorities to put an end to “these excess scalpels”, which put patients at unnecessary risk.
1 in 5 operations would be unnecessary
If mortality linked to thyroid cancer has been falling in France for 10 years, the number of cases has multiplied by 3 since 1990 (8,211 in 2012 against 2,531 in 1990). An upsurge linked to the new detection of small, even tiny nodules (less than 1 cm, or even 2 mm).
However, these small nodules, even cancerous, very often do not evolve. They should therefore not be removed but only subject to regular monitoring.
Yet even today, doctors operate too often for nodules that are not even cancerous. According to a Health Insurance report (1) mentioned by UFC investigators, 21% of ablations are performed for nodules that are actually benign.
In addition, about 40% of cancerous nodules are so small and mild that they should not be removed right away.
Que Chooser’s conclusion, “One in five thyroid ablation is unnecessary. “
How to explain this overtreatment?
The main explanation for the French overtreatment lies in the fact that preliminary examinations are not practiced enough, as eminent members of the French Endocrinology Society deplore in the monthly.
A high-quality ultrasound combined with a fine-needle aspiration (analysis of the cells taken) make it possible to estimate the nature of the nodule: in 65% of cases, they turn out to be benign. However, one in 5 operated people did not have an ultrasound and 7 out of 10 did not have a fine needle aspiration.
The risks of overtreatment are far from benign
Operating for nothing can put patients at unnecessary risk. If the complications are rare (less than 1%), they do exist: death (19 cases in 2010), bruises or abscesses that may require a new intervention, voice disorders, lack of calcium, scar …
Most importantly, after complete thyroid removal, patients must take the replacement therapy (thyroid hormone) they need to stay alive.
UFC calls for the proper application of official recommendations
In view of the overtreatments denounced in France, and the scientific studies which accumulate to denounce the excessive practice of thyroid ablation, “UFC-Que Choisir refuses the passivity of the French public authorities” and proposes to review the existing model . On the one hand, the consumer association asks the Health Insurance to publicly address this public health problem, in particular through an awareness campaign aimed at all patients.
On the other hand, the Federal Union of Consumers wishes to alert the Haute Autorité de Santé to the urgent need to develop documented and up-to-date recommendations for physicians, and to conduct a campaign to recall good medical practices concerning the load of a thyroid nodule.
(1) Health insurance expense and income report of July 2013
.
