20 Dec Thyroid Cancer: Does Increased Detection Lead to Overdiagnosis?

MedicalResearch.com Interview with:

Dr. Marti

Jennifer L Marti MD FACS
Assistant Professor of Surgery, Breast & Endocrine Surgery
Weill Cornell Medicine, New York, NY

Luc GT Morris MD, Co-senior author
Head & Neck Surgery
MSKCC, New York, NY

MedicalResearch.com: What is the background for this study?

Response: The incidence of thyroid cancer has increased dramatically over the past 3 decades. There is controversy whether this increased incidence is due to increased detection of an existing reservoir of disease, versus a true increase in the occurrence of the disease, due to an environmental carcinogen or other factors (eg obesity).

MedicalResearch.com: What are the main findings? 

Response: With SEER data, we observed a plateau and recent decline in the incidence of small papillary thyroid cancers. This is likely due to implementation of the 2009 American Thyroid Association (ATA guidelines) limiting the indications for fine needle aspiration (FNA) of subcentimeter thyroid nodules, and stricter guidelines in 2015 advocating for no FNA of any subcentimeter thyroid nodules, even if suspicious.

These findings demonstrate that thyroid cancer incidence rates are very sensitive to our use of medical technology to identify subclinical disease. This indicates that the prior dramatic increase in incidence rates is more likely to have been due to increased detection, rather than a true increase in occurrence due to the environment or other causes such as obesity.

MedicalResearch.com: What should readers take away from your report? 

Response: These findings indicate that overdiagnosis (diagnosis of a condition that would not cause a symptom or death), can be partially combated by decreased biopsies, and therefore spare thousands of patients the potential harms of unnecessary treatments such as thyroidectomy and radioactive iodine, as well as associated anxiety, and personal financial burdens that may ensue.

We should consider overdiagnosis occurring across the board in all areas of medicine, especially in cancer screening programs.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Continue to examine the thyroid cancer incidence trends as the ATA guidelines for thyroid FNA are more widely adopted. And consider how we can  limit our indications for biopsies and subsequent overdiagnosis for other indolent cancers.  

Citation:

Powers AE, Marcadis AR, Lee M, Morris LGT, Marti JL. Changes in Trends in Thyroid Cancer Incidence in the United States, 1992 to 2016. JAMA. 2019;322(24):2440–2441. doi:https://doi.org/10.1001/jama.2019.18528

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Last Updated on December 20, 2019 by Marie Benz MD FAAD