A team of UCLA researchers found that there are several parts of California where, in a high percentage of people with thyroid cancer, the disease is already at an advanced stage by the time it is diagnosed.
The research was led by Dr. Avital Harari, a member of the UCLA Jonsson Comprehensive Cancer Center and assistant professor of surgery.
Approximately 63,000 people were diagnosed with thyroid cancer nationwide last year, and according to the National Cancer Institute (NCI), the incidence of thyroid cancer has increased across racial, ethnic and gender lines over the past several decades. When detected early, thyroid cancer is treatable and even curable. However, survival rates are much lower for people who are diagnosed at advanced stages of the disease.
The UCLA scientists examined county-by-county data from the California Cancer Registry for 27,000 people who had been diagnosed with thyroid cancer from 1999 to 2008. To ensure that they were comparing similar population sizes, the researchers grouped together some smaller counties for the analysis.
Nationally, about 29 percent of people with thyroid cancer have advanced-stage disease by the time it is diagnosed, according to data from the NCI's surveillance, epidemiology, and end results program, also known as SEER. Of the 47 geographical areas the UCLA researchers analyzed, 20 had significantly higher percentages than that, ranging from 33 percent (Orange County) to 51 percent (for the combination of Alpine, Amador and Calaveras counties).
Overall, in 35 percent of Californians with thyroid cancer, the disease has reached the regional and/or distant metastatic stage, meaning that it has spread beyond the thyroid to other tissues in the neck, regional lymph nodes or other parts of the body, by the time it is diagnosed--6 percentage points higher than the national average.
According to the UCLA findings, the California counties (or combined county groups) where people were most likely to have advanced thyroid cancer at the time of diagnosis were:
1.Alpine, Amador and Calaveras (combined): Disease was advanced in 51 percent of those with thyroid cancer
2.Imperial: 48 percent
3.Sutter: 45 percent
4.San Francisco: 41 percent
5.Santa Barbara: 40 percent
Southern California counties outside of the top five were San Bernardino, which ranked 12th (37 percent of people with thyroid cancer had advanced-stage disease), San Diego (13th, 36 percent), Los Angeles (14th, 35 percent), Fresno (17th, 34 percent), Ventura (18th, 34 percent) and Orange (20th, 33 percent).
The counties with the highest percentages of people with advanced cancer were not grouped together in any obvious geographic pattern, meaning that none of the larger regions within the state seem to have a higher risk for the disease than any other.
The UCLA researcher said it is not clear why the incidence of advanced-stage thyroid cancer is that much higher in California than the national average, but her research suggests there might be an environmental component.
"California has the largest amount of farmland in the country, so this type of exposure could very well contribute to our thyroid cancer rates," Harari said.
However, the only known environmental risk factor for thyroid cancer is radiation exposure, and that alone is unlikely to fully explain the phenomenon.
The next stage of Harari's research will evaluate possible links between thyroid cancer and exposure to pesticides and radon.
The study is available online in the Journal of Surgical Research.
Patient Stories:
Ana Carolina Borges Fernandes, 17, thyroid cancer survivor
Ana Carolina Borges Fernandes, 17, will not allow her thyroid cancer diagnosis define her outlook on life.
"I don't want people to feel sorry for me, because I had to go through cancer treatment at such a young age," said Borges Fernandes.
The Santa Monica High School senior was just 16-years-old when she felt a lump on the right-side of her neck. At first, she didn't think it was a concern until her doctor examined the lump and immediately ordered a biopsy. The test results were devastating for Borges Fernandes and her parents, when doctors told the teenager that she had locally advanced thyroid cancer, which had spread to several lymph nodes in her neck.
"Doctor Harari removed my thyroid gland and all of the lymph nodes in the middle and right side of my throat, but she didn't touch the left side, because it wasn't affected," Borges Fernandes said.
The teenager was then prescribed radio-active iodine supplements, over a three week period, to kill microscopic cancer cells possibly left behind after the surgery.
Borges Fernandes understands that there is a 30-percent chance the cancer can recur; however, she's already showing signs of making a full recovery and is currently cancer free.
For the first time, since her cancer diagnosis, Borges Fernandes is looking forward to spending the holidays with her family and also preparing to fill out college applications, instead of only focusing on her health.
Ashley Goodall, 25, thyroid cancer survivor
Ashley Goodall is determined to make a difference in the world, despite some of the health related setbacks she has faced in her young life.
At 22, Goodall was concerned about a lump on her neck, which at times she said caused her to choke. Doctors in Bakersfield diagnosed Goodall with a calcified nodule; but they didn't believe it was cancerous. Goodall told her doctors that her mother was also diagnosed with thyroid nodules, though her mother's doctors never determined if they were cancerous. Goodall's doctors decided to use an ultrasound machine to monitor the nodule every six months, instead of removing it.
After years of checkups, Goodall decided to get a second opinion at UCLA and met with Harari--who examined the nodule the same way and immediately determined that it was cancerous, and had spread throughout her neck in several lymph nodes.
"Doctor Harari removed my whole thyroid and some lymph nodes above my collarbone and the side of my neck." Goodall said.
Goodall is also struggling to cope with a condition, she was diagnosed with when she was 11, called Complex Regional Pain Syndrome or CRPS, also known as Reflex Sympathetic Dystrophy (RSD) Syndrome. The key symptom is chronic, intense pain that is out of proportion to the severity of the injury (if an injury occurred) which gets worse over time rather than better. It most often affects the arms, legs, hands or feet.
Since the condition is rare, Goodall started an organization called "Rock Out to Knock Out RSD" to show support for others--who have been diagnosed with this disorder--so they feel like they aren't alone.
Goodall has this advice for people, questioning their diagnosis and treatment by their current physician.
"Today I am cancer free, thanks to doctor Harari. She gave me my life back, so make sure to get a second opinion. When it means your health you have to put yourself first," Goodall said.
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