Active surveillance of low-risk papillary thyroid carcinoma (part II): history of disease progression, quality of life and cost effectiveness

Abstract

The dramatic increase in the incidence of thyroid cancer in recent decades, which is pri- marily due to increased detection of papillary thyroid microcarcinomas (PTCM), has led to a significant increase in the costs associated with thyroid cancer care. Despite this increase in the worldwide incidence, the mortality associated with these tumors has remained unchanged. Consequently, several groups of researchers have suggested that low-risk papillary thyroid carcinomas (PTC) have been overdiagnosed and overtreated. Active surveillance (AS) has emerged as a new therapeutic alternative for these tumors, with excellent oncological results, lower complication rates, and which could help reduce economic costs. However, despite the encouraging results of AS, its implementation in practice depends on many aspects including the radiological characteristics of the tumor, the clinical characteristics of the patient, psychosocial factors and socioeconomic factors. In this review we will focus on describing the evidence accumulated to date regarding the natural history of PTC kinetics, cost effectiveness of VA, and current limitations to its implementation.