Thyroid Cancer Diagnosis: Delays During the Pandemic, Implications and Trends

A recent article from JAMA Otolaryngology–Head & Neck Surgery focuses on the impact of the COVID-19 pandemic on thyroid cancer diagnoses. Here we highlight the implications of delayed access to treatment the pandemic caused and significant disruptions in healthcare.

Impact on Thyroid Cancer Diagnoses

The COVID-19 pandemic led to a significant reduction in nonurgent health care utilization, including cancer diagnoses. Guidelines from various health organizations, such as the Centers for Medicare & Medicaid Services and the American College of Surgeons, recommended postponing lower-acuity treatments and surgeries. This resulted in a sharp decrease in thyroid cancer incidence rates during the initial wave of the pandemic in 2020.

Trends in Incidence Rates

Thyroid cancer incidence rates declined markedly in March 2020 and then partially recovered by the end of 2020. However, with the emergence of new COVID-19 variants (Alpha and Delta), there were further declines in incidence rates during 2021. This ongoing trend suggests stresses within the healthcare system and changes in utilization over time.

Undiagnosed Cases

The study estimates that approximately 10,200 cases of thyroid cancer went undiagnosed in the US from March 2020 to December 2021. Most of these undiagnosed cases comprised small papillary thyroid cancers, often found incidentally during routine healthcare visits. Other histologic types, including follicular, medullary, and anaplastic cancers, also suffered from deficits in diagnosis, though to a lesser extent.

Cancer Size at Diagnosis

Despite the decrease in healthcare utilization, there was no significant increase in the mean size of thyroid cancers at diagnosis. This suggests that the decline in incidence was not due to prioritizing larger nodules for workup but rather a generalized decrease in healthcare services. Notably, the mean size of papillary thyroid cancers had been on the rise before the pandemic, a trend that continued during 2020 and 2021.

Implications of Delayed Access to Treatment

The delayed diagnosis of thyroid cancers could result in several adverse outcomes:
– Higher Stage at Presentation. Undiagnosed cancers may present at a more advanced stage when they are eventually diagnosed, potentially increasing morbidity and mortality rates.
– Increased Need for Aggressive Therapies. Patients with delayed diagnoses might require more aggressive treatments, which can negatively impact their quality of life and survival rates.
– Mortality Displacement. Some patients who would have been diagnosed with aggressive cancers like anaplastic thyroid cancer may have died from other causes, such as COVID-19 or related illnesses, before their cancer was identified.

Future Implications

The study emphasizes the necessity for ongoing monitoring of cancer diagnosis rates and the size of cancers at diagnosis. Understanding the long-term effects of the pandemic on cancer care is crucial. Future planning and monitoring efforts should consider the potential for increased rates of patients presenting with larger or more advanced stage cancers, as these undiagnosed cases from 2020 and 2021 come to light.

In summary, the impact of the COVID-19 pandemic on thyroid cancer diagnoses resulted in significant disruptions to healthcare services, leading to a substantial number of undiagnosed thyroid cancer cases. These delays in diagnosis could have long-term implications for patient outcomes, highlighting the need for careful monitoring and strategic planning to mitigate these effects.