The 1st Italian Thyroid Cancer Summit at the Senate of the Republic, an important moment of confrontation - promoted by ITCO - between institutions, clinicians, researchers and patient associations on the future of thyroid cancer management in Italy, was successfully concluded.

The Italian Thyroid Cancer Observatory Foundation (ITCO), founded in 2013, is now a national reference point for the study and management of thyroid cancer pathologies. With more than 70 centres distributed throughout Italy, the Observatory monitors more than 15,000 patients and records 2,500-3,000 new cases of thyroid cancer each year. The ITCO database collects data from centres of excellence, metropolitan hospitals and territorial facilities, providing a complete picture of the management of thyroid cancer in Italy.

This will allow the analysis and comparison of diagnostic and therapeutic strategies, with a particular focus on local specificities and inequalities in access to care. In addition to being an advanced operational model, the Observatory is characterised by a multidisciplinary approach that integrates clinical, social and economic expertise, acting as an innovative platform to optimise diagnostic and therapeutic practices, reduce inequalities and provide scientific evidence to improve standards of care.

Based on a national network that brings together 70 reference centres, the Italian Thyroid Cancer Observatory, in addition to its scientific and clinical value, has a fundamental educational mission, offering an opportunity for growth to young researchers and clinicians, fostering a fruitful dialogue between the academic world, health institutions and patient associations throughout the country", emphasises Rector Antonella Polimeni. "Sapienza will continue to support with conviction the activities of the Observatory, which embody our University's commitment to promoting the transfer of knowledge in the service of public health".

During the conference, the results of the ITCO 2025 Report, summarising over ten years of activities, were presented. ‘ITCO represents a unique model of scientific collaboration, based on the voluntary commitment of centres that, in addition to their normal workload, have chosen to contribute to this common vision,’ began Sebastiano Filetti, ITCO Data Analysis Coordinator, Professor Emeritus at Sapienza University of Rome and one of the Observatory's founders.

‘At a time when data fragmentation is a critical issue for the Italian healthcare system, ITCO is determinedly pursuing the promotion of a culture of quality data, an essential element to support clinical and organisational decisions for the benefit of institutions, scientific societies and patients.’ ‘ITCO's guiding principle is based on three pillars: measure to manage, measure to improve, share to progress,’ emphasises Federico Serra, ITCO's Director General.

A significant picture emerges from the data: thyroid carcinoma in Italy has a high incidence rate compared to other European countries, while maintaining a stable and low mortality rate. This paradox, the experts present explained, is largely caused by overdiagnosis, which raises questions about current diagnostic strategies. ‘It is essential to avoid turning healthy individuals, asymptomatic and with a very low probability of developing a serious disease, into cancer patients, thus reducing the levels of overdiagnosis and overtreatment, as recommended by the guidelines of scientific societies,’ said Luigino Dal Maso, Statistical-Epidemiologist Researcher at the Aviano Centro di Riferimento Oncologico.

‘We must remember that today there are more than 240,000 people living after a diagnosis of thyroid cancer and they risk having to suffer the long-term consequences of unnecessary treatments, in addition to social discrimination for becoming cancer patients,’ added Salvatore Vaccarella, Researcher at the Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France. ‘On the other hand, a small percentage of diagnosed individuals develop a clinically relevant disease, for the early identification of which the most advanced technologies must be used,’ continued Giorgio Grani, Professor at Sapienza University of Rome.

 ‘In order to be able to do this efficiently and with the appropriate focus on optimising healthcare expenditure, we need not only scientific and technological knowledge, but also a clear and coherent regulatory framework that favours collaborative research and information exchange’.

The ITCO 2025 Report provides an updated and comprehensive analysis of thyroid cancer management in Italy, highlighting significant diagnostic and therapeutic advances, as well as the challenges to be faced. The analysis painted a clear picture of the critical issues and opportunities in the national context, as well as the problem of overdiagnosis. ‘Research continues to be a fundamental pillar in the fight against thyroid cancer.

Understanding risk factors, as well as implementing preventive measures, are crucial to reducing the incidence and improving the quality of diagnosis and treatment. Constant efforts are needed to raise awareness and update strategies to ensure increasingly targeted and effective management,' said Senate Vice President Maria Domenica Castellone, among the authorities attending the conference.

As a matter of fact, the research conducted by ITCO highlighted several risk factors for thyroid carcinoma, including radiation exposure, environmental contamination (especially in volcanic and mining areas), iodine deficiency, and genetic predisposition. The national iodoprophylaxis programme organised and coordinated by the Istituto Superiore di Sanità, under the supervision of Dr Olivieri, confirms itself as a virtuous example of collaboration between the scientific community and institutions, demonstrating the effectiveness of large-scale preventive interventions.

The Observatory's data also allow us to grasp the differences in thyroid cancer management between metropolitan and peripheral areas, while also analysing the impact of social, cultural and economic factors on treatment outcomes. Therefore, the issues of treatment and territorial disparities were also carefully discussed by the experts. Indeed, the analysis of clinical practices in Italy between 2001 and 2018 revealed significant geographical disparities in surgical treatments.

In the Centre-South, total thyroidectomies account for 88% of operations, compared with 77% in the North, with a total thyroidectomy/partial thyroidectomy ratio that peaked at more than 10 in the South in 2012. Lobectomy, recommended for low-risk nodules <1 cm, is performed in only 10% of cases (compared to 25-30% internationally). Despite the decline in radioiodine use over the last decade, 20% of patients with tumours <1 cm continue to receive it without evidence of benefit.

Treatment of thyroid cancer is evolving towards an increasingly personalised approach, integrating different therapeutic modalities: active surveillance for low-risk cases, use of minimally invasive techniques such as thermoablation, targeted molecular therapies for aggressive and refractory forms, and the introduction of innovative immunotherapy protocols for more complex cases.

ISS President Rocco Bellantone, who spoke with a magisterial reading on the evolution of thyroid carcinoma surgery, also emphasised how achieving greater effectiveness in treatment, diagnostic and therapeutic protocols, and inter-professional processes benefits not only patients, but all citizens and the healthcare system:

 ‘Adopting the model proposed by ITCO requires a joint and coordinated effort between healthcare professionals, political authorities and the research community. Only through effective cross-sectoral collaboration will it be possible to translate scientific evidence into homogeneous clinical practices, reducing the phenomenon of overdiagnosis and ensuring that each patient, regardless of geographic area, has access to accurate diagnostic pathways and therapeutic treatments that are sustainable in the long term. The goal of combining diagnostic accuracy and therapeutic sustainability is not only an organisational challenge, but also an ethical obligation for the healthcare system'.

The experts then discussed the opportunities represented by diagnostic innovation. The integration of ultrasound, cytology and molecular biology is now the gold standard for risk stratification in thyroid carcinoma, with the aim of reducing unnecessary thyroidectomies by 30-40%. The adoption of Digital Pathology within the ITCO project is a crucial strategy to reduce territorial disparities, ensuring uniform access to advanced diagnostic expertise throughout the country.

The introduction of Artificial Intelligence, currently in the validation phase, promises to automate the morphological analysis of images, integrating clinical and molecular data to make increasingly precise and personalised therapeutic decisions, as suggested by Professor Crescenzi, ITCO Vice President and lecturer at Sapienza University and Professor Tallini, University of Bologna.

The overall analysis, presented at the Summit, thus highlighted a number of key priorities to be implemented. Addressing all stakeholders in the health system, from policy makers to clinicians, from scientific societies to patient associations and industry, Cosimo Durante, ITCO President and Professor at the Sapienza University of Rome, presented a 10-point manifesto outlining a series of priorities and strategic objectives.

The presidents of the main scientific societies and patient associations attending the Summit agreed on the affirmation of ITCO as a model of excellence in scientific and operational collaboration, bringing together multidisciplinary expertise to address the growing challenges related to thyroid neoplasia. In particular, they reiterated how the Observatory's data, which constitute an objective source of the contemporary management picture of thyroid cancer in Italy, are used by scientific societies and associations to identify critical issues to be corrected and to structure targeted training programmes for their members.

As well as being a reference point for data collection and analysis, the ITCO plays a crucial role in promoting change in healthcare, both nationally and internationally. By facilitating dialogue between clinicians, researchers, institutions and patients, the Observatory promotes the integration of research and clinical practice with the aim of raising standards of care and ensuring increasingly personalised, innovative and sustainable treatments.

The Summit also hosted the awarding ceremony of the Aldo Pinchera and Ernst Mazzaferri prizes to Massimo Santoro and Riccardo Vigneri, internationally renowned researchers who have made significant contributions to basic and clinical research on thyroid carcinoma, and the Celestino Pio Lombardi prize to Silvia D'Elia and Simone De Leo, two young researchers who have enhanced the data collected by the Observatory with their work.