The Ethics of Observing Low-Risk Thyroid Cancer

The reported incidence of thyroid cancer has increased dramatically due to improved access to healthcare and high-quality imaging modalities. Most newly diagnosed thyroid cancers are papillary thyroid microcarcinomas, with typically indolent courses and extremely favorable clinical outcomes without treatment. This raises the question of overdiagnosis and overtreatment of the disease, which may lead to unwarranted risks. The 2015 American Thyroid Association guidelines included active surveillance as an alternative treatment option for low-risk papillary thyroid microcarcinoma in addition to immediate surgery. Despite initial promising results, active surveillance has not been widely adapted worldwide due to physician concerns and attitudes towards safety of active surveillance, patient and societal beliefs regarding cancer, and the paucity of long-term data on clinical outcomes. Concurrent with this has been the introduction and proliferation of radio frequency ablation as an outpatient treatment option for thyroid lesions, including small cancers. Increased education and shared decision making between the physician and patient can help establish a safe and effective personalized treatment strategy.