Ventura County has one of the highest rates of thyroid cancers in all of California’s 58 counties. According to the California Cancer Registry, Ventura County had the highest rate of thyroid cancers from 2011-15, and the second highest rate from 2014-15. More recent but not-yet-confirmed reports suggest Ventura may have slipped to third place — leaving it still near the top. Yet few county residents are talking about it, and practically no thyroid cancer survivors are willing to speak publicly about their experience.
Local thyroid cancer seems to be the issue without a face.
Cancer patients have always faced some level of stigma. Discrimination in both housing and hiring has been reported. But some cancers are more talked about than others. If celebrities or respected members of a community speak out about their cancer experience, stigma can be lessened, and societal support follows. But that’s not happening around the county’s thyroid cancers.
The high rates have the look of a silent condition. The VCReporter exhausted all usual methods of finding survivors to be photographed for this story. But it was a fruitless search. Perhaps more talking about it out in the open will lead to a greater amount of openness, to drive down stigma about something happening right here at home.
Why are the rates so high? The reasons are unknown. There is currently no solid medical research that points to one factor. A combination of several factors is likely. Pesticides, which are abundant in agricultural industries and landscaping, may be contributing.
Modern medical tests are much improved over older ones. Detection is better and could account for the increase. Although the number of cases has risen, the total number of fatal cases has not. This could be due to better treatment of what used to be fatal cases.
Rates are rising nationwide. “The incidence of thyroid cancer has increased quite dramatically across the country as a whole in the past decade or so,” Dr. Tricia Westhoff-Pankratz, of Loma Vista Endocrinology in Ventura, told the VCReporter. “We have seen increases in both genders, and all ethnic backgrounds, but generally thyroid cancer is 2.5 times more likely in women than men.”
The rate of fatal cases has not changed, which Westhoff-Pankratz sees as evidence of over-diagnosis. “Many endocrinologists believe the higher incidence is due to more neck ultrasounds and biopsies being done by doctors, in an era of litigation and the ‘over-scanning’ syndrome,” Westhoff-Pankratz said. Many thyroid cancers, even undetected ones, “may never pose a problem for the patient.
“I continue to see a large number of thyroid cancer cases, at all stages of the disease,” Westhoff-Pankratz said. “Traditional risk factors for thyroid cancer are childhood radiation therapy, fallout from nuclear weapons or nuclear power plant accidents, and family history of thyroid cancer. I do not know why these factors would be more prevalent in Ventura County,” compared to other counties.
Dr. Avital Harari co-authored the 2016 study, “Increased Rates of Advanced Thyroid Cancer in California,” showing the state has more advanced thyroid cancers than the U.S. average.
Factors “may include environmental impacts and/or delays in diagnosis,” Harari told the VCReporter in an email. Harari’s research shows that minorities, “including Asians, African-Americans and Hispanics, tend to present later with their disease, regardless of their socio-economic status. I also found that obese patients presented with later-stage disease.” Although these findings were helpful, “I did not think it was explaining all of what we were seeing,” she said.
Harari found that half of all California counties have more patients seeking thyroid treatment at advanced stages, rather than at early stages, compared to the rest of the U.S.
“It is a huge deal,” she said. “Since the later the disease is caught, the more extensive the surgeries” that are needed.
A thyroid disease specialist and associate professor of endocrine surgery at UCLA’s Geffen School of Medicine, Harari noted that many physicians believe the high rates are due to over-diagnosis. “I am not one of those physicians. Those like me believe there is much more involved in this exponential growth of thyroid cancer and the increased advanced disease we are seeing, namely an environmental component.”
The rates spurred Harari to look deeper into something she had noticed since 2009. “When I moved to California,” she said, “I noted that in my practice I was operating on many more advanced thyroid cancers than in my training in the rest of the country, especially in young women. Historically, most patients with thyroid cancer present between 40-60 years of age. However, in California, I was seeing many patients from 18-25 years old with significantly advanced disease. Given how often I was seeing this, I started investigating risk factors for thyroid cancer here.”
“It’s not easily explainable,” Harari said.
Search for Answers
Harari is investigating the possible role of pesticides. But pesticides might not be the only factor. “Radiation might come into play,” she explained. “Maybe even pollution. There are a number of factors to consider. A colleague of mine recently also associated flame retardants with thyroid cancer, although that is not unique to California, so I am not sure it explains our state’s unique distribution of disease.”
Are cases being counted accurately? A California Department of Public Health representative confirmed to the VC Reporter that, “Health care providers, hospitals, and cancer treatment facilities are required by law to submit reports of cancer diagnoses and treatment to the California Cancer Registry. “CCR is “probably the most comprehensive cancer registry in the country,” Harari said.
When a biopsy or surgery reveals cancer, it is reported and given a unique identification number, Harari explained. “The data is de-identified when you access it so that you do not know who the person is, but it is very valuable data that we can learn from. Each case has addresses that are associated with the date of diagnosis, treatment facilities and other information. Thus you can track where the cancers are being diagnosed and at what stages.”
The CCR website does not contain any identifiable information about individuals.
For women, problems in the thyroid gland can be hard to diagnose because the symptom of excessive sweating is also a symptom of menopause, so it can be unclear whether sweating is the result of thyroid problems or menopause.
Ventura County resident Susan Storer was diagnosed as having nodules on her thyroid six years ago, and has had annual ultrasound tests to monitor them ever since. Nodules are small lumps or swelling.
“Monitoring the size of the nodules is important, to see if they are growing,” she told the VCReporter. “If the nodules grow, it’s a bad sign.”
Thyroid diagnoses is an inexact science, in Storer’s experience. One nodule seen on her most recent ultrasound seems to have become larger, but Storer said that different radiologists have different analyses of the ultrasounds, so it’s not always clear if changes have taken place.
Her original symptom of excessive sweating was what led her doctor to suggest the annual ultrasounds. “They put me on different medications at that time, because it wasn’t clear if it was hypo-thyroidism or hyper-thyroidism.” Hyper-thyroidism is an overactive thyroid, while hypo-thyroidism means the gland is underactive. After six years of monitoring, she still does not know which of the two types of thyroid conditions it might be.
She is awaiting the results of a second ultrasound, to clarify what diagnosis and treatment recommendations might come next.
Six years ago when the nodules were first confirmed, Storer was prescribed medication, but she said that the medication had side effects, so she is no longer taking it. It was not possible to sort out whether her symptoms were due to menopause or to a thyroid condition.
“They put me on different meds to see if I was hypo or hyper,” she said. “The side effects left me not feeling well. The tests still haven’t determined if my thyroid is hypo or hyper.”
What’s known so far
An Environmental Health Perspectives study found that manufactured chemicals leaking from factories into soil and water may disrupt thyroid functions of pregnant women and developing infants; this is critical to brain development. Per- and polyfluoroalkyl substances, called PFAS and PFOA, are toxins found in many manufactured products, and have been linked to thyroid disease. PFAS and PFOA pollution has been documented at 94 sites in 22 states, at fire-training facilities, military bases, airports and industrial plants. Some farmers are unable to sell milk and beef because of PFOA in the soil and water that animals ingest. The resulting financial hardships have hurt agricultural industries in Colorado, Pennsylvania, New Mexico, West Virginia, Ohio, Michigan, New Hampshire and Maine.
A cluster of thyroid cancer cases has arisen in Iredell County, North Carolina, including an abnormally high rate near Duke Energy Corporation’s Marshall Steam Station. Duke Energy states that there is no connection between their operations and thyroid cancer. But patients disagree. “It’s extremely frustrating,” said local physician Dr. Scott Lynn. His daughter and ex-wife were both diagnosed with thyroid cancer.
Down to earth
Radon gas is found in soil, and is in the spotlight as thyroid cases climb. Scientists are investigating radon’s possible link to thyroid cancer. Odorless and colorless, radon is the radioactive decay of uranium that can seep from rocks naturally, or from radiation-related exposure such as nuclear testing. Radon in small amounts lurks in many homes, but in the past been considered dangerous only at high levels.
“There is no link right now,” National Radon Services Program Coordinator Brian Hanson told the VC Reporter. “It’s not impossible, but it is not a likely cause.” No connection has been established because, according to Hanson, “It’s not been looked at clinically.”
There are test kits for determining home radon levels, sold by the National Radon Center, and there are remedial kits that lower radon to safe levels. Test kits cost $15-25. The process to reduce radon to safe levels costs between $800 and $2,000, or $3,000 for large homes. California’s Residential Disclosure Report is required for all real estate transactions, so that homebuyers will be aware of natural hazards present on a for-sale property. Elevated radon levels are classified as a “natural hazard” by the state.
“As far as radon goes, it’s embedded in our soil here in Ventura County,” Heidi Golff, eXp Realtor and Luxury Certified Zillow Premier Agent, told the VCReporter.
For homebuyers, the radon level “is disclosed as a part of the mandatory natural hazards report, and people are told they can have testing done to see about the property they are buying, and that there’s a way to mitigate it,” Golff said. “The few I’ve seen who do express concern tend to come from different parts of the country where the issue is taken more seriously and where homes are routinely tested. I’ve been told that there is nowhere, really, where they can buy here without radon being present and that some parts of the county are worse than others. I don’t know if that’s true.”
What’s true is not clear. In Westhoff-Pankratz’s experience, “There is controversy about whether potential occupational exposure plays a role, and I have seen a fair amount of X-ray technicians, firefighters, airline pilots and others with radiation and chemical occupational exposures who developed thyroid cancer. I cannot comment as to whether Ventura County has a larger number of these occupations than other areas. I used to work in Los Angeles and saw a large number of cases there as well.”
“Has anyone I know actually done (radon testing) as a part of their investigations before closing escrow? No, and I’ve closed over 300 homes here,” Golff said. “It’s my job to bring it up and encourage them to test, but it’s their decision.” In her experience, buyers have the information needed to decrease the amount of radon in the home.
“What I see is that no one does it.”