As cancer deaths overall have dropped 20 percent in two decades, thyroid-cancer deaths have edged up slightly, and the number of new cases is climbing.
Some of that is because of better and earlier detection. But many experts think there’s more to it.
The good news is that thyroid cancer is getting significant attention from researchers supported by federal grants, including a recent $11.3 million National Cancer Institute award to the cancer centers at Ohio State University and the University of Texas’ MD Anderson. That’s on top of
$11.2 million Ohio State received for a recently renewed thyroid research project.
“It’s really no longer considered a rare cancer,” said Dr. Matthew Ringel, Ohio State’s director of endocrinology, diabetes and metabolism and a thyroid-cancer expert.
Better imaging and biopsy techniques have improved the discovery of cancer, but there’s also been an increased incidence of larger tumors, which is harder to explain, Ringel said. Radiation is the best-understood risk factor for thyroid cancer, but that is uncommon.
“We really don’t have a great feel for the risk of developing it. Most times there’s not an obvious family history,” Ringel said.
The disease is diagnosed in women about three times as often as in men (scientists are trying to understand why), and incidence is highest in people in their 40s and 50s.
Most cancers are found before they’ve spread, and in those cases, almost everyone survives at least five years. Symptoms of the disease include a lump on the neck, vocal changes such as hoarseness, difficulty swallowing, pain in the neck and throat, and swollen lymph nodes.
Four new research projects (three here, one in Texas) focus on genetics and thyroid cancer: predicting which patients will experience significant side effects from one medication and finding a strategy to prevent that; developing second-line treatments for patients whose advanced-cancer treatment is failing; and looking for biological markers to predict how aggressive a particular cancer will be and how it will respond to treatment.
All aim to move research quickly from the lab to the clinic, where patients will benefit.
“It clearly is an exciting time for research in the field,” said Gilbert Cote, a researcher and professor at MD Anderson in Houston.
Most advances have been made by small groups supported by philanthropic organizations, he said. “ I think it has signaled to the National Institutes of Health that it’s time to up the game a little bit.”
Cote said he considers the millions of federal dollars now being devoted to the research remarkable in light of the tight research budget.
His team is focusing on a rarer type of thyroid cancer, medullary, which tends to be more aggressive. The project aims to better tailor care to patients based on the genetics of their tumors. They’re also working toward a blood test that would help track the effectiveness of treatment, Cote said.
Rebecca Nagy, a genetic counselor at Ohio State, is working on projects to better understand how an individual’s genetics contribute to thyroid cancer, both in families with multiple cases and in individuals with no known family history.
Nagy said she hopes the work will lead to tests that can determine
thyroid-cancer risk in people who don’t yet have the disease and to the discovery of disease pathways that could serve as targets for new medications.
What is clear so far is that a genetic explanation for thyroid cancer, even in families with multiple cases, is far from simple, Nagy said.
“You can’t go find the same mutation in the same gene in all the families,” she said. “That makes our job very difficult.”