Active surveillance for papillary thyroid microcarcinoma: New challenges and opportunities for the health care system

Grace C. Haser, R. Michael Tuttle, Henry K. Su, Eran E. Alon, Donald Bergman, Victor Bernet, Elise Brett, Rhoda Cobin, Eliza H. Dewey, Gerard Doherty, Laura L. Dos Reis, Jeffrey Harris, Joshua Klopper, Stephanie L. Lee, Robert A. Levine, Stephen J. Lepore, Ilya Likhterov, Mark A. Lupo, Josef Machac, Jeffrey I. MechanickSaral Mehra, Mira Milas, Lisa A. Orloff, Gregory Randolph, Tracey A. Revenson, Katherine J. Roberts, Douglas S. Ross, Meghan E. Rowe, Robert C. Smallridge, David Terris, Ralph P. Tufano, Mark L. Urken

Research output: Contribution to journalReview articlepeer-review

57 Scopus citations


Objective: The dramatic increase in papillary thyroid carcinoma (PTC) is primarily a result of early diagnosis of small cancers. Active surveillance is a promising management strategy for papillary thyroid microcarcinomas (PTMCs). However, as this management strategy gains traction in the U.S., it is imperative that patients and clinicians be properly educated, patients be followed for life, and appropriate tools be identified to implement the strategy. Methods: We review previous active surveillance studies and the parameters used to identify patients who are good candidates for active surveillance. We also review some of the challenges to implementing active surveillance protocols in the U.S. and discuss how these might be addressed. Results: Trials of active surveillance support nonsurgical management as a viable and safe management strategy. However, numerous challenges exist, including the need for adherence to protocols, education of patients and physicians, and awareness of the impact of this strategy on patient psychology and quality of life. The Thyroid Cancer Care Collaborative (TCCC) is a portable record keeping system that can manage a mobile patient population undergoing active surveillance. Conclusion: With proper patient selection, organization, and patient support, active surveillance has the potential to be a long-term management strategy for select patients with PTMC. In order to address the challenges and opportunities for this approach to be successfully implemented in the U.S., it will be necessary to consider psychological and quality of life, cultural differences, and the patient's clinical status.

Original languageEnglish
Pages (from-to)62-611
Number of pages550
JournalEndocrine Practice
Issue number5
StatePublished - 2016


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