Detección mayor de tumores de bajo riesgo aumenta tasas de cáncer de tiroides

Información proporcionada por: Mayo Clinic

El cáncer de bajo riesgo que no presenta síntomas y supuestamente tampoco ocasiona problemas futuros es la causa del rápido aumento en la cantidad de nuevos casos de cáncer de tiroides diagnosticados en la última década, señala un estudio de Mayo Clinic, publicado en la revista Thyroid. Los autores del estudio dicen que cerca de 33% de esos casos recientes se diagnosticaron después de que el médico clínico empleara imágenes de alta tecnología, pese a la ausencia de síntomas de enfermedad tiroidea.

“Es verdad que se encuentran más cánceres, pero son los que posiblemente no ocasionan daños”, comenta el autor principal del estudio, Dr. Juan Brito Campana, profesor adjunto de medicina en Mayo Clinic. “Sin embargo, el tratamiento tiende a ocasionar daños porque la mayoría de cánceres de tiroides se trata mediante la extirpación quirúrgica completa o parcial de la glándula tiroides, lo que constituye un procedimiento riesgoso que puede afectar las cuerdas vocales del paciente o dejarlo de por vida con deficiencias de calcio”. 

El Dr. Brito señala que el daño no se limita al sufrimiento físico. “El tratamiento puede ocasionar dificultades económicas para los pacientes, sus familiares y la sociedad misma porque se gastan millones de dólares en cirugías innecesarias y problemáticas”, añade.

Según el Dr. Brito, el costo nacional agregado de estos procedimientos en Estados Unidos fue de 1600 millones de dólares en 2013 y posiblemente excederá de 3500 billones de dólares en 2030. De manera simultánea a esto, la incidencia del cáncer de tiroides aumenta con mayor rapidez que la de los demás tipos de cáncer, lo que lo encamina hacia convertirse en la tercera causa más común de cáncer femenino.

En este estudio, el Dr. Brito y sus colegas extrajeron datos del Proyecto Epidemiológico de Rochester y analizaron los expedientes de 566 hombres y mujeres diagnosticados con cáncer de tiroides en el condado de Olmsted, Minnesota, entre 1935 y 2012. Examinaron de manera específica la cantidad de casos nuevos de cáncer de tiroides, las muertes debidas a la enfermedad y el método de diagnóstico.  

Los científicos descubrieron una duplicación en la cantidad de casos nuevos de cáncer de tiroides en los últimos años, desde 7,1 por cada 100 000 personas entre 1990 a 1999, hasta 13,7 por cada 100 000 personas entre 2000 y 2012. Durante ese mismo período, la cantidad de pacientes nuevos con cáncer de tiroides y síntomas permaneció igual, mientras que la cantidad de nuevos casos de cáncer de tiroides silencioso (tipo de cáncer en que los pacientes no presentan síntomas) casi se cuadruplicó. La proporción de pacientes con cáncer de tiroides que muere por la enfermedad no ha cambiado desde 1935.

El estudio descubrió que las razones más frecuentes para la identificación del cáncer de tiroides silencioso fueron las siguientes: revisión del tejido de la tiroides debido a afecciones benignas (14 por ciento); descubrimiento accidental en un examen por imágenes (19 por ciento); e investigaciones desencadenadas por estudios radiológicos del cuello (27 por ciento) en pacientes con síntomas o nódulos palpables claramente no relacionados con el cáncer de tiroides.  

“Estamos ante una epidemia de diagnósticos de cáncer de tiroides”, acota el Dr. Brito. “Ahora que se sabe la procedencia de estos nuevos casos, es posible desarrollar tácticas para identificar a los pacientes con cáncer de tiroides que podrían beneficiarse del tratamiento sin sentenciar a otros pacientes a exámenes, tratamientos, sufrimientos y costos innecesarios”.

  

Los científicos dicen que un método de reducir la detección de estas lesiones sería limitando el uso de ciertas tecnologías por imágenes y otra táctica sería conseguir que el paciente deliberase sobre sus alternativas de tratamiento. En muchos casos, la vigilancia activa puede ser preferible a la cirugía en los pacientes con cáncer pequeño y relativamente benigno que puede tardar décadas en crecer hasta un tamaño apreciable u ocasionar problemas mortales. 

El Dr. Brito considera que algo tan simple como no usar la palabra “cáncer” para referirse a estas pequeñas lesiones silenciosas de la tiroides puede reducir la cantidad de tratamientos innecesarios cuando el pronóstico es más favorable. En lugar de llamar cáncer de tiroides a estas lesiones, el médico recomienda emplear un término de menor carga emocional, tal como lesiones papilares de curso indolente. 

Otros autores del trabajo son la Dra. Alaa Al Nofal, el Dr. Víctor Montori, el Dr. Ian Hay y el Dr. John Morris III, todos de Mayo Clinic.

El estudio fue posible gracias a los recursos del Proyecto Epidemiológico de Rochester, sustentado por el Instituto Nacional del Envejecimiento que pertenece a los Institutos Nacionales de Salud (R01AG034676).


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