Disparities Exist in Surgical Management of Thyroid Cancer

A spectrum of disparities exist in the surgical management of well-differentiated thyroid cancer, according to new data presented at the 82nd Annual Meeting of the American Thyroid Association (ATA) in Québec City, Québec, Canada.

Current ATA guidelines for well-differentiated thyroid cancer recommend therapeutic neck dissection for clinically involved or metastatic disease and prophylactic central neck dissection for advanced tumors. However, even with established guidelines in place, the surgical management of cervical nodes varies greatly.

A team of researchers led by Katherine Hayes, MD, of Emory University in Atlanta, Ga., reviewed data on 127,192 patients with papillary and follicular thyroid cancer who were treated surgically from 1998 to 2009 to identify disparities in the extent of lymph node dissection during thyroidectomy. Variables examined included patient age, race, gender, insurance status and education level, hospital classification, surgical volume, and size of tumor.

Thyroidectomy alone was performed in 51.1%, while 48.9% also had lymph nodes dissected. Patients with tumors > 1 cm were significantly more likely to have nodes removed during surgery (RR 1.2, CI 1.19–1.22) relative to tumors < 1 cm. Older patients and African Americans were less likely to have any nodes removed (RR 0.75, CI 0.74–0.77 and RR 0.64, CI 0.62–0.66, respectively). Patients treated at National Cancer Institute Designated Centers were more likely (RR 1.13, CI 1.1–1.15) to have > 3 lymph nodes removed, as were patients with tumors > 1 cm (RR 1.25, CI 1.21–1.28). However, women (RR 0.87, CI 0.85–0.88) and African Americans (RR 0.89, CI 0.85–0.93) consistently had fewer lymph nodes removed.

“These new data show that, in spite of existing guidelines, clinician preferences as well as patient characteristics all too often contribute to a number of disparities in the extent of surgery for well-differentiated thyroid cancer,” said Elizabeth Pearce, MD, of the Boston Medical Center and Program Co-Chair of the ATA annual meeting.

About the ATA Annual Meeting

The 82nd Annual Meeting of the American Thyroid Association is held Sept.19-23, in Québec City, Québec, Canada. This four-day creative and innovative scientific program, chaired by Elizabeth Pearce, MD, Boston Medical Center, and Douglas Forrest, PhD, National Institute of Diabetes and Digestive and Kidney Diseases, carefully balances clinical and basic science sessions on the latest advances in thyroidology. The ATA meeting is designed to offer continuing education for endocrinologists, internists, surgeons, basic scientists, nuclear medicine scientists, pathologists, endocrine fellows and nurses, physician assistants and other health care professionals.

About the ATA

The American Thyroid Association (ATA) is the leading worldwide organization dedicated to the advancement, understanding, prevention, diagnosis and treatment of thyroid disorders and thyroid cancer. ATA is an international individual membership organization with over 1,600 members from 43 countries around the world. Celebrating its 89th anniversary, ATA delivers its mission through several key endeavors: the publication of highly regarded monthly journals, THYROID, Clinical Thyroidology and Clinical Thyroidology for Patients; annual scientific meetings; biennial clinical and research symposia; research grant programs for young investigators, support of online professional, public and patient educational programs through thyroid.org; and the development of guidelines for clinical management of thyroid disease.