Results of screening in familial nonmedullary thyroid cancer.

Klubo-Gwiezdzinska J1, Yang LA2, Merkel R3, Patel D4, Nilubol N5, Merino M6, Skarulis MC7, Sadowski S8, Kebebew E9,10.

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Abstract

BACKGROUND:

Although a family history of thyroid cancer is one of the main risk factors for thyroid cancer, the benefit of screening individuals with a family history of thyroid cancer is not known.

METHODS:

We performed a prospective cohort study with yearly screening using neck ultrasound and fine needle aspiration biopsy (FNAB) of the thyroid nodule(s) >0.5 cm in at risk individuals whose relatives were diagnosed with familial nonmedullary thyroid cancer (FNMTC). The eligibility criteria were the presence of thyroid cancer in ≥2 first-degree relatives, and an age of >7 years. Twenty-five kindred were enrolled in the study (13 families with 2 members affected, and 15 with ≥3 members affected at enrollment).

RESULTS:

Thyroid cancer was detected by screening in 4.6% (2/43) of at risk individuals from families with 2 members affected, and in 22.7% (15/66) of at risk members from families with ≥3 patients affected (p=0.01). FNMTC detected by screening was characterized by a smaller tumor size (0.7 cm+/-0.5 vs. 1.5+/- 1.1, p= 0.006), a lower rate of central neck lymph node metastases (17.6% vs. 51.1%, p=0.02), a less extensive surgery [hemi-thyroidectomy 23.5% vs. 0%, p=0.002] and a lower rate of radioactive iodine therapy (23.5% vs. 79%, p<0.001) as compared to those affected at enrollment.

CONCLUSIONS:

Screening of at risk family members resulted in earlier detection of low-risk FNMTC and was associated with a less aggressive initial treatment. Screening with thyroid ultrasound should be considered in kindred with ≥3 family members affected by FNMTC. Since active screening might be associated with the risk of overtreatment, it should be implemented with caution specifically in elderly individuals.