Last week there was an announcement in the journal JAMA Oncology. An international panel of physicians has reclassified a type of tumor that has long been considered malignant as non-cancerous. This change will affect approximately 10,000 of the nearly 65,000 thyroid cancer patients diagnosed annually in the United States. This means those patients will not have to undergo removal of their thyroid, treatment with radioactive iodine, and regular examination for the rest of their lives, all just to protect against a tumor that was never life-threatening.
This will undoubtedly open the door to possible reclassification of some other types of tumors, including certain lesions in the prostate and breast.
The tumor reclassified by the scientists is a small lump in the thyroid that is completely encapsulated by fibrous tissue. The nucleus looks like cancer, but the cells have not broken free of the capsule, and the panel determined surgery to remove the entire thryroid, along with the ensuing treatment, is unnecessary and harmful to the patient.
This type of tumor was previously called an “encapsulated follicular variant of papillary thyroid carcinoma.” The new name is “noninvasive follicular thyroid neoplasm with papillary-like nuclear features,” or NIFTP. The word “carcinoma” has been eliminated.
Because of constant advances in diagnostic equipment, and our improved ability to observe and identify pathology much earlier, tiny premalignant lumps in the breast have become known as stage zero cancer. Tiny, early-stage lesions of the prostate have come to be called cancerous tumors. Lumps that we would never have seen in the past are now visible with ultrasound M.R.I.s and CT scans, particularly in the thyroid. Yet longitudinal studies show these tiny tumors post no threat.