It’s the newest trend in the treatment of papillary thyroid cancer (PTC)--you know, that histology that accounts for the vast majority of all differentiated thyroid cancers. With a global increase in the use of medical imaging, the recognized incidence of PTC is steadily rising while its death toll, particularly among younger patients, remains remarkably modest. Thus the emergence of active surveillance for low risk (read: <1.5 cm without extrathyroidal extension) PTC. Following the lead of the Japanese, head and neck surgeons at MSKCC confirm via their own experience that most patients with PTC can avoid surgery altogether since close to 90% of tumors fail to grow even 5 mm over 5 years. Interestingly, this data also demonstrates that tumor growth kinetics matter more than than absolute tumor growth. In other words, PTC growth appears to be exponential such that a 50% relative increase was more telling than an absolute increase of 5 mm (the Japanese threshold for consideration of resection). Want more? This week’s JAMA editorial can bring you up to speed.


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