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New Personalized Approach to Thyroid Cancer Avoids Routine Radiation

April 23, 2015

Dr. Paul Walfish, pioneer in the area of thyroid cancer

Thyroid cancer has one of the fastest rising incidences among all cancers in developed countries. Up until recently, it was believed that almost all patients with thyroid cancer required post-surgical treatment with radioactive iodine, which can potentially have long term effects such as the growth of other cancers, salivary disease or dry mouth. However, a recently published report in the journal Endocrine from a team of physicians from Mount Sinai Hospital’s Division of Endocrinology and Department of Otolaryngology-Head & Neck Surgery has demonstrated that radioactive iodine may not be necessary for most low- and intermediate-risk patients.

“This research has the potential to significantly change the post-operative treatment of thyroid cancer if adopted by other centres,” says Dr. Ian Witterick, Mount Sinai’s Otolaryngologist-in-Chief, who was part of the team of researchers.  “Instead of determining the need for radioactive iodine based on age and tumour size, we are now using an objective biomarker named Thyroglobulin measured in each patient’s blood, in combination with their neck ultrasound, to assess their individual risk. It’s a personalized approach to care.”

Personalized medicine, sometimes referred to as “precision medicine”, is an approach to clinical care that uses a patient’s unique biomarkers as a guide to the best course of treatment for that individual patient, rather than treatments based on composite data from other patients with similar risk factors.  

“This research is an excellent example of personalized medicine – using readily available tests to identify the very best course of treatment,” adds Dr. Witterick.

Mount Sinai Hospital has a long standing reputation in thyroid cancer care through its Joseph & Mildred Sonshine Family Centre for Head & Neck Diseases and Alex and Simona Shnaider Research Laboratory in Molecular Oncology.  Previous contributions by Dr. Paul Walfish, a pioneer in the area of thyroid cancer, such as fine needle aspiration biopsy and thyroid ultrasound to assess thyroid nodules, have allowed for much earlier detection of thyroid cancer.

“One of the reasons we believe this discovery is significant is because we have come so far in the detection of early stage thyroid cancer that the vast majority of our patients are now considered to be of low or intermediate risk for recurrence or death, and represent approximately 80% of all detected thyroid cancers” says Dr. Walfish, who was the principal researcher on the Mount Sinai-led study.  “This new approach to treatment will affect a significant portion of thyroid cancer patients who may avoid routine radiation, following a ‘curative’ total thyroidectomy.”

“This work is a source of pride for our entire team, and most importantly, represents an advance in the appropriate treatment for our patients,” adds Dr. Witterick. Co-authors of this study, in addition to Drs. Walfish and Witterick, included Drs. Steven Orlov, Farnaz Salari, Lawrence Kashat, Jeremy Freeman and Allan Vescan.