For Maria Papaleontiou, MD, Research Holds the Key to Improving Care of Patients With Thyroid Cancer

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Maria Papaleontiou, MD, whose research interests focus on the complex issues surrounding the management of thyroid cancer and thyroid disease in general, was born on Cyprus, a small island nestled in the azure waters of the Mediterranean Sea. She recently spoke with The ASCO Post about her life and work in cancer research.

“As a young girl, I remember wanting to pursue a career in medicine, to do something to help people. My parents are not in medicine but they have always been supportive of my early interest in becoming a doctor,” shared Dr. Papaleontiou.

Maria Papaleontiou, MD

Trading Tropical Paradise for Frigid Midwest

“I HAD A LOT of family living in the United States, and when I was 16, I applied for a Fulbright and Howard Hughes Medical Institute Scholarships. I was thrilled to be awarded these scholarships and came to the States the following year, where I attended Macalester College, a small liberal arts school in St. Paul, Minnesota. It was quite different going from a warm island in the Mediterranean to a place that is freezing cold and snow-bound a good portion of the year.”

Dr. Papaleontiou did her premedical studies at Macalester College, majoring in biology and chemistry. Toward the end of her undergraduate work, she struggled with the decision of whether to return to Europe for medical school, to be closer to her family, or to remain in the United States. She decided to return to Europe, attending Charles University in Prague, historically known as the University of Prague, which is the oldest and largest university in the Czech Republic.

Asked why she chose to attend medical school in the Czech Republic, Dr. Papaleontiou explained: “Two of my relatives in Cypress went to medical school at Charles University and had a great experience, so I said to myself, why not. While in medical school, I originally thought about pediatrics but then settled on internal medicine. And during that period, I became very interested in endocrinology. Among other things, I found the complexity of the hormonal system intellectually challenging.”

A Tough Decision

AFTER RECEIVING her medical degree, Dr. Papaleontiou decided to return to the United States and obtain experience in clinical research. “I didn’t know exactly what research area I wanted to pursue, but in 2006, after looking at several opportunities, I went to Weill Cornell Medical College in New York. There, I worked as a clinical/researcher in geriatrics and aging studies with Cary Reid, MD, PhD, who was an amazing mentor and still is to this day,” said Dr. Papaleontiou.

After spending several years conducting research at Weill Cornell Medical College, Dr. Papaleontiou began an internal medicine residency at St. Peter’s University Hospital in New Jersey. After residency, she began a fellowship in metabolism and endocrinology at the University of Michigan (U-M), where her combined interest in endocrinology and geriatrics sparked her interest in thyroid cancer. She joined the faculty in 2013.

“After becoming a faculty member at U-M, I became active in the American Thyroid Association, and my interest in thyroid cancer really bloomed. I began applying for research funding, and in 2016, I received a K08 career development award from the National Institute on Aging, focusing on overtreatment with thyroid hormone in older adults, including those with thyroid cancer. I’m especially interested in the issue of overtreatment of thyroid cancer, because I think it gives us a window into the larger issues faced, not only in cancer care, but also in our health-care delivery system at large,” noted Dr. Papaleontiou.

Do No Harm

ASKED TO DESCRIBE some of her current research in thyroid cancer, Dr. Papaleontiou replied: “I was the author on a large population-based study that identified three groups of patients with thyroid cancer, most likely to be at risk for postoperative complications, namely those older than 65 years old, those with comorbidities and those with advanced thyroid cancer. This study was conducted under the mentorship of Dr. Megan Haymart, an expert in thryoid cancer health services research. This research is especially relevant: as thyroid cancer rates rise, more people are having surgery to remove all or part of their thyroid.”

Dr. Papaleontiou and her associates found that overall, 6.5% of patients with thyroid cancer had general postoperative complications in the month after surgery, and 12% had complications specific to thyroid surgery within a year of the operation. However, the risks were significantly higher for certain groups as mentioned above, suggesting the opportunity for targeted interventions and education to improve outcomes. “The fact that 12% of patients overall have thyroid surgery–specific complications is concerning. Most of our surgeons quote a 1% to 3% rate. This is quadruple what we had thought,” said Dr. Papaleontiou.

They found that older patients were about three times more likely to have complications than those younger than age 65. Advanced disease was associated with the highest number of complications, with 23% of patients whose cancer had spread throughout the body having thyroid surgery–specific complications, a finding that Dr. Papaleontiou found “shocking.”

“Thyroidectomy is generally considered a fairly safe operation. However, some populations are more vulnerable and need extra attention in pre-and postoperative care,” she added.

More Work Needed

ASKED WHETHER researchers fully understand what is causing the marked increase in thyroid cancer detection and treatment, Dr. Papaleontiou responded: “There have been several studies done, but none that have satisfactorily quelled the debate on this issue in the thyroid cancer world. However, we do know that increased use of imaging has created an increase in incidentally discovered thyroid cancers. Some studies looking at patients who have died of other causes than cancer have found that about 30% of these patients had microcarcinomas in their thyroid glands. We still need more work in this area to have a clearer clinical answer to explain the growing incidence of this cancer.…”

She continued, “That said, just as in low-risk prostate cancer and breast ductal carcinoma in situ, there’s a movement in thyroid cancer management toward an active surveillance approach to low-risk thyroid cancers. There are bigger questions we need to answer in these low-risk cancers: Are we doing too much? Are we creating unnecessary worry and potential harms for our patients? We’ve made huge progress in cancer diagnosis and treatments, but we always should examine our clinical practices to make sure that everything we do is in the best interest of our patients.”

DISCLOSURE: Dr. Papaleontiou reported no conflicts of interest.