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Invited Commentary
October 2017

Achieving Active Surveillance for Thyroid Cancer—Not a Euphemism for Watching a Ticking Time Bomb

Author Affiliations
  • 1Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, Ohio
JAMA Otolaryngol Head Neck Surg. 2017;143(10):1021-1022. doi:10.1001/jamaoto.2017.1453

Thyroid cancer has been recognized as the most rapidly increasing cancer in the United States, tripling in incidence over the past 3 decades. It is estimated that there will be 56 870 new cases in the United States (42 470 in women and 14 400 in men) in 2017. The mortality from thyroid cancer has remained stable and low, with 2010 deaths estimated this year.1 Increased diagnostic testing, particularly with ultrasonography, has been responsible for much of this rise in incidence. Acknowledging that many subclinical papillary thyroid cancers (PTCs) are being detected that may not cause symptoms or death2-4 and that treatment toxic effects may not be inconsequential, strategies to personalize treatment have been explored. Most recently, active surveillance has been endorsed for the first time by the American Thyroid Association guidelines as an alternative to a traditional treatment approach in carefully selected patients.5 Although support for active surveillance has been established in Japan,6 there has been limited evidence in the United States or other countries for this approach.

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