Balancing the Benefits and Harms of Thyroid Cancer Surveillance in Survivors of Childhood, Adolescent and Young Adult Cancer: Recommendations From the International Late Effects of Childhood Cancer Guideline Harmonization Group

Author of the resource: Clement SC, Kremer LCM, Verburg FA, Simmons JH, Goldfarb M, Peeters RP, Alexander EK, Bardi E, Brignardello E, Constine LS, Dinauer CA, Drozd VM, Felicetti F, Frey E, Heinzel A, van den Heuvel-Eibrink MM, Huang SA, Links TP, Lorenz K, Mulder RL, Neggers SJ, Nieveen van Dijkum EJM, Oeffinger KC, van Rijn RR, Rivkees SA, Ronckers CM, Schneider AB, Skinner R, Wasserman JD, Wynn T, Hudson MM, Nathan PC, van Santen HM.

Radiation exposure to the thyroid gland during treatment of childhood, adolescent and young adult cancer (CAYAC) may cause differentiated thyroid cancer (DTC). Surveillance recommendations for DTC vary considerably, causing uncertainty about optimum screening practices. The International Late Effects of Childhood Cancer Guideline Harmonization Group, in collaboration with the PanCareSurFup Consortium, developed consensus recommendations for thyroid cancer surveillance in CAYAC survivors.

These recommendations were developed by an international multidisciplinary panel that included 33 experts in relevant medical specialties who used a consistent and transparent process. Recommendations were graded according to the strength of underlying evidence and potential benefit gained by early detection and appropriate management. Of the two available surveillance strategies, thyroid ultrasound and neck palpation, neither was shown to be superior. Consequently, a decision aid was formulated to guide the health care provider in counseling the survivor. The recommendations highlight the need for shared decision making regarding whether to undergo surveillance for DTC and in the choice of surveillance modality.