SCREENING FOR THYROID CANCER IN PATIENTS WITH FAP

NEW YORK (Reuters Health) Jan 25 - Ultrasound screening can detect potentially curable thyroid cancer in patients with familial adenomatous polyposis (FAP), researchers report online in the January Annals of Surgery.
"While patients with FAP (especially women) are known to be at increased
risk for thyroid cancer, there has been no concerted effort to provide screening," Dr. James M. Church told Reuters Health by email.
To investigate the yield from ultrasound thyroid screening in patients with this rare cancer predisposition syndrome, the researchers from the Cleveland Clinic in Ohio employed the approach in 192 patients undergoing annual gastrointestinal surveillance from August 2008 to December 2009.
In all, 72 (38%) had thyroid nodules, none of which were palpable, and 5 (2.6%) had thyroid cancer. Four of the patients had the multifocal papillary type with a mean size of 15 mm. Three of the patients with cancer were women.
None of the cancers were detected based on clinical history or neck examination.
The 2.6% incidence of thyroid cancer is significantly higher than the 0.2% historically reported for the general population.
The fact that the thyroid cancers detected were small and asymptomatic, say the investigators, "Gives credibility to the notion that ultrasound screening can lead to diagnosis and treatment of earlier-stage thyroid cancers."
"This study shows that simple neck ultrasound screening is effective in detecting asymptomatic, unsuspected, curable thyroid cancer. The thyroid cancer risk in FAP is high enough that such screening should be offered to all patients." Dr. Church concluded.
Ann Surg. Posted January 4, 2011. Abstract