P. Williamson et al., THE GENETIC-ASPECTS OF MEDULLARY-THYROID CARCINOMA - RECOGNITION AND MANAGEMENT, Journal of the Royal College of Physicians of London, 30(5), 1996, pp. 443-447
Objective: to examine the extent to which clinicians recognize the gen
etic aspects of medullary thyroid carcinoma (MTC) and undertake approp
riate investigation and management of patients and their at-risk relat
ives. Design: retrospective review of case notes. Subjects: all indivi
duals aged 70 or under with a 'raised' calcitonin level during 1990-91
. Information was obtained from a questionnaire. Forty-one cases were
diagnosed in 1990-91: 70 (24%) multiple endocrine neoplasia (MEN) type
2A, four (10%) MEN type 2B, and 27 (66%) sporadic MTC. Between 1980 a
nd 1989, 87 cases were diagnosed: 20 (23%) MEN type 2A, six (7%) MEN t
ype 2B, four (5%) familial MTC, 53 (61%) sporadic MTC, and four (5%) o
f uncertain diagnosis. Main results: a pedigree was drawn in only 7/37
(19%) and 26/83 (31%) of cases diagnosed in 1990-91 and 1980-89, resp
ectively where a family history had been taken. All known hereditary c
ases were investigated for phaeothromocytoma. In 9/27 (33%) and 14/52
(27%) apparently sporadic cases diagnosed in the two periods respectiv
ely, no investigations were performed. Genetic counselling was offered
to all known hereditary cases except one, but no offer was made in 11
/25 (44%) and 16/52 (31%) apparently sporadic cases. There was no reco
rd that screening should be offered to the family in 15/35 (43%) and 2
5/68 (37%) cases identified from clinical investigations; in the major
ity it could be argued that it should have been. Conclusions: this stu
dy has shown that clinicians do not always have the necessary training
or experience to undertake family studies and screening in this rare
disorder.