Disparities in surgical management of thyroid cancer

A spectrum of disparities exists in the surgical management of well-differentiated thyroid cancer. Katherine Hayes, MD, of Emory University in Atlanta, Georgia led the research, which was presented at the 82nd Annual Meeting of the American Thyroid Association (ATA) in Quebec City, Quebec, Canada.

Currently, ATA guidelines for well-differentiated thyroid cancer recommend therapeutic neck dissection when the disease is clinically involved or metastatic and prophylactic central neck dissection when tumors are advanced. Nonetheless, though these established guidelines are in place, the surgical management of cervical nodes varies greatly.

The research team reviewed data on 127,192 patients with papillary and follicular thyroid cancer who were treated surgically between 1998 and 2009. They sought to identify disparities in the extent of lymph node dissection during thyroidectomy.

A total of 51.1% of the patients were treated with thyroidectomy alone, and 48.9% also had lymph nodes dissected. Lymph nodes were more likely to be removed during surgery for patients with tumors larger than 1 cm compared with tumors less than 1 cm (relative risk [RR] 1.2, 95% confidence interval [CI] 1.19-1.22). Patients who were older and those who were African American were less likely to have any nodes removed (RR 0.75, 95% CI 0.74-0.77 and RR 0.64, 95% CI 0.62-0.66, respectively). If patients were treated at National Cancer Institute designated centers, they were more likely to have more than three lymph nodes removed (RR 1.13, 95% CI 1.1-1.15), and so were patients with tumors larger than 1 cm (RR 1.25, 95% CI 1.21-1.28). Fewer lymph nodes were consistently removed for women (RR 0.87, 95% CI 0.85-0.88) and for African Americans (RR 0.89, 95% CI 0.85-0.93).

“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.
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