Celebrity Factor: Raising Awareness for Thyroid Cancer

Park So-dam

Over the past few years, several celebrities have come forward to discuss their diagnoses and treatment for thyroid cancer, most recently South Korean actress, Park So-dam, one of the lead actors in the Oscar-winning film Parasite. Park was diagnosed with papillary thyroid cancer in late 2021, and she publicly shared her diagnosis in an official statement put out by her professional representation. She regularly posts to her social media accounts to update her fans on her progress and provide reassurances about her health.

She is not the only celebrity who has been public about their thyroid cancer diagnosis.

Stephanie Smooke Praw, MD

Sofia Vergara, well-known for her role on the sitcom Modern Family, first spoke publicly about her diagnosis in an article for Health in 2011. At that time, she commented she did not want any attention around her diagnosis until she had completed her initial surgery and radioactive iodine ablation. Vergara credited early detection for helping her achieve remission. "I was fortunate to have caught it early and to have the support of my doctors and most importantly, my family," Vergara said during a Stand Up To Cancer event in 2021. "I learned a lot during that time, not just about thyroid cancer but I also learned that in times of crisis, we're better together and if we're going to end cancer, it's going to require a team effort." Both actors noted that their thyroid nodules were found on physical examination.

Conversely, in 2017, Shark Tank's Daymond John spoke about his thyroid cancer diagnosis which was made during an "executive physical." In an article in People, he noted, "I just want to share my story to empower people to take control of their health. This is something we all have to be diligent about." Whether thyroid enlargement was noted on physical examination or screening ultrasound is unclear.

Do these public announcements help raise awareness or create an outsize fear of diagnosis of thyroid cancer?

Raising Awareness About Thyroid Cancer

Although most thyroid cancer outcomes are favorable, maintaining awareness of thyroid disease remains important. Approximately 44,280 adults (12,150 men and 32,130 women) were diagnosed with thyroid cancer in 2021, with the lifetime risk of developing thyroid cancer being 1.2%, according to the Surveillance, Epidemiology, and End Results thyroid cancer database. Thyroid cancer is the seventh most common cancer diagnosed in women and accounts for 2.3% of all cancer diagnoses. Localized, well-differentiated thyroid cancer is associated with a 5-year survival rate of almost 100%. The 5-year survival rate for regional papillary thyroid cancer is 99% and decreases to 50% for more advanced cancers.

While most patients are unable to access an "executive physical" such as John's, this publicity does raise concerns in the realm of health equity in medical care. Asymptomatic patients without significant risk factors (ie. childhood exposure to head and neck irradiation, inherited genetic syndrome associated with thyroid cancer, or a first-degree relative with thyroid cancer) should be encouraged to have annual physical examinations with their primary physician and referral for imaging if thyroid enlargement, nodules, or lymph nodes are noted.

At this time, screening ultrasound are not recommended. The US Preventive Services Task Force (USPSTF) found inadequate evidence to recommend screening ultrasound, stating that "the magnitude of the overall benefits of screening and treatment can be bounded as no greater than small, given the relative rarity of thyroid cancer, the apparent lack of difference in outcomes between patients who are treated versus monitored (for the most common tumor types), and observational evidence showing no change in mortality over time after introduction of a mass screening program."

Although the USPSTF found inadequate evidence to support harm associated with screening ultrasound, they did conclude that "overdiagnosis and overtreatment are likely to be substantial with population-based screening." Overall, the USPSTF determined that the net benefit of screening for thyroid cancer is negative (D recommendation).

Check Your Neck

Public health campaigns such as "Check Your Neck" provide encouragement to the public for screening; however, the documentation regarding numbers of thyroid cancer cases or thyroid nodules elicited through this approach is lacking.

Nor have studies have been done to examine the direct risks to patients of screening for thyroid cancer using neck palpation or ultrasound. Yet, screening may be associated with overdiagnosis. This is supported by data that screening is associated with increased incidence of disease without any associated change in mortality.

Finally, no randomized trials have compared patient outcomes in those patients with screen-detected, well-differentiated thyroid cancer vs patients who did not receive screening, according to a review by Lin and colleagues published in JAMA. As a result, could screening create more burden for patients without associated benefit?

Perhaps the best example of increasing incidence of papillary thyroid cancer without impact on cancer-associated mortality comes from data from screening programs in South Korea as reported in Medscape. On review of data from the 2010 Korean Community Health Survey, a strong correlation was found between regional screening and incidence (r = 0.77; 95% CI, 0.70-0.82). In addition thyroid screening was associated only with increased detection of papillary thyroid cancer (r = 0.74; 95% CI, 0.59-0.88]), not with death from thyroid cancer (r = -0.08; 95% CI, -0.59 to 0.63]).

In this population, cancer screening converted thousands of asymptomatic people into patients with thyroid cancer. According to a 2014 article in the New England Journal of Medicine, two thirds of these patients were treated with total thyroidectomy and one third with subtotal thyroid surgery, without any overall impact on mortality.

Celebrity Factor and Thyroid Cancer

So, what is the impact of celebrities on raising awareness for thyroid cancer? Celebrities and public figures have come forward to help raise awareness of screening for colon cancer, breast cancer, and heart disease, among other conditions. Tom Hanks' diagnosis of diabetes raised awareness for the condition when he spoke about on CBS's The Late Show With David Letterman and during a 2013 interview with the BBC.

In the Medscape article "The Tom Hanks Effect: Diabetes Diagnosis Great for Awareness," Dr Anne Peters of the University of Southern California endorsed the importance of Hanks' transparency in sharing his diagnosis and raising awareness of the disease. Hanks served as a positive role model by sharing his diagnosis and progress in diabetes control.

When celebrities like Hanks disclose that they have a disease, it can have a big impact, generating important discussions.

I agree with Dr Julie Ann Sosa, chair of the Department of Surgery at UCSF and incoming president of the American Thyroid Association. She said, "Can the same be done for thyroid cancer? If we can use these public disclosures of diagnosis for education and awareness, that is a positive. The downside could involve an outsize concern and overscreening for the condition or an increase in patient worry if the celebrity case has a poor prognosis or treatment complications occur (eg, recurrent laryngeal nerve injury). We also want to ensure that inaccurate information is not spread with these disclosures. "

For more diabetes and endocrinology news, follow us on Twitter and Facebook

Follow Medscape on Facebook, Twitter, Instagram, and YouTube

Comments

Commenting is limited to medical professionals. To comment please Log-in.

Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.