Endocrine Abstracts

Background: Thyroid carcinoma represents the most frequent form of cancer of the endocrine glands. In Italy, temporal trend shows a significant increase of incidence rates. Papillary thyroid cancer is the most common thyroid malignancy. Papillary thyroid carcinoma happens to be a multicentric tumor and trends to spread to the lymph nodes in the early stage of the disease. Thus early diagnosis is vital to improve the outcome for patients with thyroid cancer. The aim of this study was to determine the impact of delays in the diagnosis and treatment of this cancer.

Methods: 43 patients [median age 42 (range 19–67), male to female ratio 1:8] with papillary thyroid cancer initially referred by a general practitioner and treated within this Unit from 2002 to 2005 were evaluated. Other histologic type were excluded from the study. Incidental microcarcinomas found in a multinodular goiter were also excluded. Details of referral, investigation and treatment were obtained by patient interview and cross-referenced with the case notes. Subjects completed an utilization questionnaire. The primary outcome variable was the time duration from cancer diagnosis to the time of cancer treatment.

Results: The overall median delay from the onset of symptoms to definite treatment was 13 weeks comprising patient delay in consulting a doctor (59%), delay in referral (19%), delay in diagnosis (10%), and delay in commencing treatment (12%). No significant reduction in total delay vs or change in the stage of disease at diagnosis was identified.

Conclusion: Long-term survival rate for papillary carcinoma is more than 90%, but this varies considerably among subsets of patients. A long delay in initiating this therapy has an adverse and independent effect on prognosis. In our experience the major delay occur prior to referral (patient delay), this has traslated into a significant raise in the overall delay. To achieve this, patient awareness must also be targeted. Patients with symptoms of these diseases should be initially referred for further care or followed up.