title: ACTIVE SURVEILLANCE FOR PAPILLARY THYROID MICROCARCINOMA: NEW CHALLENGES AND OPPORTUNITIES FOR THE HEALTH CARE SYSTEM.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.forename: Grace C
authors.initials: GC
authors.lastname: Haser
authors.forename: R Michael
authors.initials: RM
authors.lastname: Tuttle
authors.forename: Henry K
authors.initials: HK
authors.lastname: Su
authors.forename: Eran E
authors.initials: EE
authors.lastname: Alon
authors.forename: Donald
authors.initials: D
authors.lastname: Bergman
authors.forename: Victor
authors.initials: V
authors.lastname: Bernet
authors.forename: Elise
authors.initials: E
authors.lastname: Brett
authors.forename: Rhoda
authors.initials: R
authors.lastname: Cobin
authors.forename: Eliza H
authors.initials: EH
authors.lastname: Dewey
authors.forename: Gerard
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authors.lastname: Doherty
authors.forename: Laura L
authors.initials: LL
authors.lastname: Dos Reis
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Harris
authors.forename: Joshua
authors.initials: J
authors.lastname: Klopper
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Lee
authors.forename: Robert A
authors.initials: RA
authors.lastname: Levine
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Lepore
authors.forename: Ilya
authors.initials: I
authors.lastname: Likhterov
authors.forename: Mark A
authors.initials: MA
authors.lastname: Lupo
authors.forename: Josef
authors.initials: J
authors.lastname: Machac
authors.forename: Jeffrey I
authors.initials: JI
authors.lastname: Mechanick
authors.forename: Saral
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authors.lastname: Mehra
authors.forename: Mira
authors.initials: M
authors.lastname: Milas
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Orloff
authors.forename: Gregory
authors.initials: G
authors.lastname: Randolph
authors.forename: Tracey A
authors.initials: TA
authors.lastname: Revenson
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Roberts
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Ross
authors.forename: Meghan E
authors.initials: ME
authors.lastname: Rowe
authors.forename: Robert C
authors.initials: RC
authors.lastname: Smallridge
authors.forename: David
authors.initials: D
authors.lastname: Terris
authors.forename: Ralph P
authors.initials: RP
authors.lastname: Tufano
authors.forename: Mark L
authors.initials: ML
authors.lastname: Urken
mesh_terms: D002291:Carcinoma, Papillary / Q000191:economics / Q000453:epidemiology* / Q000628:therapy*; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration*; D006284:Health Plan Implementation / Q000191:economics / Q000458:organization & administration; D006801:Humans; D011159:Population Surveillance / Q000379:methods*; D017410:Practice Guidelines as Topic / Q000592:standards; D011788:Quality of Life; D013964:Thyroid Neoplasms / Q000191:economics / Q000453:epidemiology* / Q000628:therapy*; D014481:United States / Q000453:epidemiology