Change in Cutoff Age from 45 to 55 Years Recommended for Staging Differentiated Thyroid Cancer

Raising the age cutoff in the current staging system for well-differentiated thyroid cancer from 45 to 55 years would help avoid overtreatment in 12% of these patients, concluded, a large multicenter study published in the March 2016 issue of ‘Thyroid.’ Jatin P. Shah, M.D., of Memorial Sloan-Kettering Cancer Center is the study’s senior author.

Differentiated thyroid cancer includes papillary, follicular, and their variants. Currently, patients under the age of 45 years are considered to be stage I, unless there is evidence of distant metastases, which then changes the staging status to stage II. In contrast, patients 45 years old or over can be staged as I, II, III, or IV, with stage IV involving distant metastases 

The staging system is from the American Joint Committee on Cancer/Union for International Cancer Controls (AJCC/UICC) and is used in the physician guidelines from the American Thyroid Association (ATA). 

Commenting on the study, Keith C. Bible, M.D., Ph.D., a medical oncologist at the Mayo Clinic, and ThyCa Medical Advisor, said that the question of most importance to patients and doctors is whether to use radioactive iodine (RAI) after a thyroidectomy. 

Dr. Bible noted that the latest ATA guidelines do not have a specific age cutoff or AJCC/UICC stage for defining whether to recommend RAI. He also noted that, as a patient, “it will be preferable to learn that you have stage II, rather than stage IV disease, so there is also the aspect of patient psychology to be considered.” 

Medscape news article

Study abstract