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Thyroid cancer cases increasing, but doctors are unsure why

January 15, 2012
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A little more than a year ago, Amber Skipper had no idea what the thyroid did. Then her baby head-butted her in the neck. The spot swelled, and Skipper, now 29, couldn’t talk.

In the following weeks, she became an expert about the gland, which helps regulate her heart rate, blood pressure, body temperature and weight. Doctors diagnosed her with thyroid cancer, which is three times more common in women than men.

The Westfield mother is part of a trend that baffles medical researchers. Thyroid cancer, which affects about 11 people per 100,000 each year, seems to be on the rise.

National Cancer Institute statistics suggest that in recent years the number of cases of this often curable cancer has increased by about 6.5 percent. Over a decade, this has added up to make thyroid cancer the fastest-increasing cancer, said Dr. Tod Huntley, an otolaryngologist and head and neck surgeon with the Center for Ear, Nose, Throat and Allergy.

“Ten years ago if I saw four new thyroid cancer patients a year, it would have been a lot,” said Dr. G. Irene Minor, a radiation oncologist with Indiana University Health Central Indiana Cancer Center. “Now sometimes I see that many in a month, and I have seen three in a week.”

Thyroid cancer is more common in women younger than 45, Minor said. Doctors don’t know why that’s the case, but thyroid problems in general — such as hyper- or hypo-thyroidism — are more common in women.

Why is it more prevalent?

Experts remain divided on the cause of the increase.

Some attribute it to better screening. Many smaller tumors are picked up on ultrasounds or scans done for other reasons, said Dr. Michael Moore, a head and neck surgeon with IU Simon Cancer Center.

Autopsies conducted on people who died for non-thyroid-related reasons reveal that as many as 80 percent of people older than 60 have a thyroid lump or malignancy that went undiagnosed, Moore said.

Some think that better screening alone can’t explain the increase in thyroid cancer. A recent study showed that the increase is not just in smaller tumors, which might have to do with detection, but also in larger ones, Huntley says.

“There is definitely something going on,” he said. “How much is due to increased surveillance and detection and how much is due to an actual biological change in disease prevalence, we don’t know, but we know it’s both.”

Obesity, radiation exposure and diets low in fruits and vegetables are three potential culprits, Huntley says. People who are overweight have a 20 percent increase in thyroid cancer; those who are obese have a 53 percent increase. The more dental X-rays a person has, the higher the risk, studies show.

Often, thyroid cancer has no symptoms but is diagnosed when a person or his physician notices a lump in the neck. When symptoms do occur they can include difficulty swallowing or the sensation of a lump in the throat or voice changes.

In Skipper’s case, she had felt something in her neck but thought it was a swollen lymph node. She had been prone to bronchitis and fatigue, but she attributed that to being a working mother with two small children.

When she learned she had cancer, she vowed to fight it. Numbers were on her side. The five-year survival rate for thyroid cancer is 97 percent.

Last October, she had her thyroid and many lymph nodes removed and underwent treatment with radioactive iodine. She now takes a daily replacement thyroid hormone pill.

Separated from family

Because the iodine is radioactive, Skipper had to be isolated from her family for seven days. She ached to see her two young daughters, now 4 and 2, as well as her husband, Ryan, who would leave her food outside her door.

After her quarantine ended — and she washed everything in sight — the Westfield mother did one thing.

“I just grabbed a hold of my family,” she said. “You definitely learn not to take things for granted.”

Four years ago, Valerie Schaewe had a spot on her neck that swelled to the size of an egg. A biopsy was inconclusive, but doctors recommended the mass be removed.

The nodule wasn’t cancerous, so the Irvington mother kept half her thyroid. Her doctor warned her that a mass might form on the remaining side of her thyroid if she had more children.

Sure enough, about six months after she had her second son in May, Schaewe, 39, felt a lump in her throat and had difficulty swallowing. Her doctor did an ultrasound and saw a large mass. She had a second operation.

“I fall into that 2 percent of cases that you don’t know until you get in there, what you’re dealing with,” she said.

Nor is she alone. Argentina’s president, Cristina Fernandez, recently had her thyroid removed for what doctors thought was a cancerous nodule. Only after the operation did they decide the mass was not cancer.

Skipper has undergone two radioactive iodine stints, the first after surgery then one a year later to see if any cancer remained. Because the thyroid “takes up” iodine, administering radioactive iodine can play both a therapeutic and diagnostic role in thyroid cancer.

In the year since her operation, Skipper started eating more organic foods and taking vitamins. She plans to complete the 500 Festival Mini-Marathon this spring. Doctors may not be able to tell her why she got cancer, but she wants to make sure she stays healthy. She also decided to become a medical assistant to help others who are sick.

Her second isolation, which lasted two days, was harder than the first. Her daughters were old enough to miss her.

At the end, she got the answer she wanted: She is cancer-free.

Says Huntley: “If you had to pick a cancer, this is what you would pick.”

Article source: http://www.indystar.com/article/20120115/LIVING01/201150304/1083/LIVING01

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