Unnecessary Radioactive Iodine?

When caught early enough, Thyroid cancer is one of the easier cancers to treat and survive.  The routine method of dealing with thyroid cancer involves both the cutting and burning methods mentioned in class; the removal of the entire thyroid organ and a radio active treatment to follow.  The radiation delivery process has been streamlined and targeting has improved over the last few decades, but none more so than the popular manner in which radiation is applied to the thyroid.  The only problem is, no one can decided exactly who needs the treatment.  As Dr. Islas has mentioned in class, the targeting of the treatment, in this case radioactivity, is a very important and difficult part of the of overall process and this fact is shown through a certain news article.  According to U.S. News' Health Day Magazine, more than 44,000 people are diagnosed with thyroid cancer in the United States each year, and every one of them is getting a very different variation of the standard treatment method, even within similar cases, at similar stages of progression.  The article, entitled "Some Thyroid Cancer Patients May Get Radioactive Iodine Unnecessarily" by Jenifer Goodwin explains that there are a very large number of lower risk, completely benign cases that are receiving the same use of radiation treatment as those patients with tumors moving towards malignancy.  But even within these claims, there seems to be so much variation within the data provided it is difficult to tell how significant the trend is.  After looking at the actual study found in the Journal of the American Medical Association, it will be interesting to see how reliable the information on cancer, given out by mainstream media, really is.
Before further analyzing the claims made by Health Day Magazine, I would like to explain exactly why the iodine delivery system for radiation therapy is widely used in thyroid cancer patients.  Iodine is crutial to the production of the two major thyroid hormones T3 and T4.  Three Iodine molecules are used to make T3, triiodothyronine, and four of the molecules are used to make T4, thyroxine (Shomon).  It is also the only gland/organ in the body which has the capability to store iodine, making it the major source of uptake in entire human system.  These facts make a delivery system based on iodine an excellent way of targeting the thyroid gland without getting much of the radiation throughout the entire system.

Back to the previous article, Health Day Magazine presents a few basic facts about the use of radiation treatment on thyroid cancer that can be summarized into a two basic areas of interest;
1.  Over Use in Early Stage Cancer Patients
2.  Extreme Variation in Use; Which Patients, Which Physicians, Which Stages

Over Use in Early Stage Cancer Patients:

The current use of the radiation therapy is guided toward the reduction of re-occurrence in later stage thyroid cancers starting move outside of the gland.  There is apparently not widespread information on the benefits and risks with earlier stage patients and yet, 37 percent of patients with stage 1 tumors are receiving the same level of radiation treatment as those with stage 4 tumors (Goodwin).  Although the iodine based delivery system is low risk, it still involves some risk including the slight chance of leukemia, damaging nearby tissue, and reproductive harm.  Are these risks worth submitting a low risk, stage one tumor patient to?  According to the original article in the JAMA, the underlying argument occurring in the situation is whether or not a universal application is advisable or the use of a doctor's choice should be the primary system of radiation administration in order to reduce overuse.(Haymart, MD, Banerjee, PhD, and Stewart, MA). Clearly, there is some sort of problem occurring with the use of the latter system, as overuse of the treatment seems to be occurring.  This is one place in the magazine article that seems to misreported, as at least the statistics are correct as shown by the lowest line in figure 1 in the JAMA article, seen on the right (I apologize for the blurred image)

but the context in which it was used was slightly wrong, leading the reader to not fully understand what is going on in the medical world.

Extreme Variation in Use:

The second large point made within the Health Day article involved the increase in use between 1990 and 2008, as well as the large variation in the use of the treatment; meaning, it is very unclear as to why many patients receive the radiation therapy while others do not.  The magazine article explains that since 1990, up to 2008 the rate of radiation use has increased 16%, from 40% of patients to 56% of patients (Goodwin).  This data is correct and pulled strait from the journal article, but some of the information following this statement about the variation of prescription leaves the reader lacking in information in a manner in which even I, if I had not have read the journal article, would not have realized.  The magazine states that "patients who had 'low-risk' disease (stage 1) were less likely to receive radioactive iodine than patients with advanced thyroid cancer (stage 4), people with stage 2 and stage 3 cancers were just as likely as those with stage 4 tumors to receive the treatment" (Goodwin), which is completely correct, but does not talk about where any of this variation comes from.  The JAMA study delves much deeper into this question within their publication of the information.  After their study was complete, an actual analysis of where the variation comes from was also completed.  The results showed that much of the variance came from hospital characteristics.  Of the wide variation found between patients, 21.1% was found to be due to patient and tumor characteristics, hospital type and patient case volume accounted for 17.1%, and amazingly enough, a whopping 29.1% of the variance could be explained by, for lack of a better term, unexplained hospital characteristics (Haymart, MD, Banerjee, PhD, and Stewart, MA).  The variance within radioactive iodine treatment is shown in fig. 2 from the journal article.

Although the magazine in question
not believe that this information

Figure 2: From JAMA

was not worth sharing with the general public, it shows two very important things;

1.  This rather longstanding treatment is still not perfectly understood by health care professionals and will be mainly administered at "better" hospitals (depending on ones theories about treatment).

2.  There is much variation that is still generally unaccounted for by hospital characteristics, which generally shows the discrepancies and uncertainties within the field.

Without sounding like too much of a conspiracy theorist, I believe that the lower level reading material, the article from Health Day Magazine, left information such as this out in order to not scare patients who may not be able to receive treatments at the higher cost hospitals.  People who cant necessarily afford to receive better treatment will, if the JAMA study holds true, not be given the radiation treatment they may need; a much scarier fact than any described in Health Day Magazine.  Clearly, for better, or for worse, the main stream media is not presenting some of the important facts necessary to completely understand the entirety of the multiple of cancer studies being conducted in this day and age.  If cancer truly is one of greatest threats to humans from a biological stand point, don't we all deserve to know the truth about what will and wont save us from our own mutating bodies?  You decide!

Works Cited:
Goodwin, Jenifer. "Some Thyroid Cancer Patients May Get Radioactive Iodine Unnecessarily." Health Day Magazine. 16 Aug 2011: n. page. Web. 6 May. 2012. <http://health.usnews.com/healthnews/familyhealth/cancer/articles/2011/08/16/some-thyroid-cancer-patients-may-get-radioactive-iodine-unnecessarily>.


Haymart, MD, Megan, Mousumi Banerjee, PhD, and Andrew Stewart, MA. "Use of Radioactive Iodine for Thyroid Cancer." Journal of the American Medical Association. 306.7 (2011): 721-728. Web. 6 May. 2012. <http://jama.ama-assn.org/content/306/7/721.full>.


Shoman, Mary. "Iodine and the Thyroid." About.com. Medical Review Board, 05 Jun 2003. Web. 6 May 2012. <http://thyroid.about.com/cs/vitaminsupplement/a/iodine.htm>.