Overdiagnosis Of Thyroid Cancer Research Articles

MON-567 Is Over Diagnosis Of Thyroid Cancer In A Non-high-income Country Impacting The Outcome Of Thyroid Cancer Surgery. An Assessment Of Surgical Outcomes In A Thyroid Cancer Referral Center In Ecuador

The frequency of thyroid surgeries has increased proportionality to the increment incidence of thyroid cancer. Yet, the number of experienced thyroid surgeons has not raised accordingly to that of thyroid cancer incidence. As a result, many thyroid surgeries are conducted by low volume surgeons that might affect the risk of surgical complications and remaining postoperative thyroid tissue. These poor surgical outcomes might be higher among countries affected by more thyroid cancer diagnosis yet with limited thyroid surgical expertise such as in a resource limited setting as Ecuador. The purpose of this study is to assess the outcomes of thyroid cancer surgery in a referral thyroid cancer center in Ecuador, and to explore the risk factors associated with poor surgical outcomes. Methods Around 344 patients with non-metastatic differentiated thyroid undergoing initial thyroid surgery (total thyroidectomy, central neck dissection) for a primary tumor were identified from an institutional database, and treated between June 1st, 2014 to December 31st, 2017. Poor surgical outcome was described in patients experience any surgical complications (recurrent laryngeal injury assessed with laryngoscopy and postoperative temporary and permanent hypoparathyroidism) or a stimulated post-operative Tg> 2mg/dL. Results Of the 344 patients, 127 patients had surgical complication and post-operative stimulated Tg data available to analyze. From this cohort, 22 (17%) patients had surgical complications, 19 (15%) hypoparathyroidism ( 8% temporary and 7% permanent) and 5 (4%) recurrent laryngeal nerve injury. A total of 74 (58%) out of 127 patients had a sTg value higher than 2 ng/ml. A poor surgical outcome was present in 88 (64%) patients. The multivariate analysis showed that the factor that was independently associated with poor surgical outcome was tumor size ≥1cm (OR: 3.3, 95% CI 1.18 - 9.3). Sex, age at diagnosis, benign non-nodular thyroid disease, BMI, place of surgery, tumor focallity, histology, extra thyroid extension variables were not- associated with poor surgical outcomes. Conclusion Two thirds of thyroid cancer surgeries, assessed in an Ecuadorian thyroid cancer referral center, had a poor surgical outcome that may lead to low patient’s low quality of life, and the need for additional treatment strategies. These estimates are higher than what is reported from the literature and suggest that the overdiagnosis of thyroid cancer in non-high-income country income countries might result in worse surgical outcomes.

A review of the propriety of thyroid ultrasound referrals and their follow-up burden.

The overdiagnosis of thyroid nodules and indolent thyroid cancers represents an increasing burden on health services, with thyroid ultrasound (US) imaging often representing the initial entry point into the thyroid nodule diagnostic pathway. The aim of this study was to retrospectively review thyroid US referrals to a single Irish hospital to determine if the stated indications for imaging had been appropriate, to review the results of the scans, and to assess the follow-up required in each case. Patient demographics, scan indications, results, and outcomes were retrospectively reviewed for all patients undergoing thyroid ultrasound from 2012 to 2016. Data were analyzed using GraphPad Prism and expressed in mean ± standard deviation. In total, 318 patients (mean age 53 ± 15 years, 85% female) had at least one ultrasound. Most US scans were performed for appropriate indications in order to follow up known thyroid nodular disease and/or malignancy (34.3%), to assess new thyroid goiters or discrete neck lumps (33.3%), and to follow up incidental findings from other imaging modalities (12.6%). However, scans were also requested (in the absence of any palpable goiter or mass) for choking/neck pain/swallowing complaints (12.3%), hypo/hyperthyroidism (6.6%), and miscellaneous reasons (0.6%) that were deemed either potentially or likely inappropriate. Of these scans, approximately half of the identified nodule(s) were deemed unlikely to be related to the stated symptoms, but which subsequently required follow-up imaging ± biopsy. No cases of malignancy were identified. In our center, a significant percentage of thyroid US scans along with their subsequent follow-up were potentially avoidable.

Thyroid cancer in Friuli Venezia Giulia, northeastern Italy: incidence, overdiagnosis, and impact of type of surgery on survival.

Incidence rates of thyroid cancer (TC) increased in the last decades worldwide. This study aimed to describe TC incidence in the Friuli Venezia Giulia (FVG) region, to estimate the quota of overdiagnosis, and to investigate the impact of surgery on long-term survival after TC diagnosis. TC cases reported to the FVG population-based cancer registry during 2002-2013, aged <85 years, were included. Age standardized rates (ASR) on the European population were computed, while proportion of TC overdiagnosis was estimated in comparison with expected age-specific incidence rates from published time series. Adjusted hazard ratios of death, with 95% confidence intervals, were also estimated. During 2002-2013, 1701 TC cases were reported to the FVG cancer registry, with papillary TC (78.2%) as the most frequent histologic type. ASR increased from 12.4 to 16.5 in women and from 4.3 to 6.2 in men (+33.1% and +44.2%, respectively). Overdiagnosis was estimated as 79% of TC cases in women and 64% in men. Almost all TC cases (97.1%) underwent surgery, including 84.6% of women and 78.9% of men who underwent total thyroidectomy. Up to 10 years after TC diagnosis, the type of surgery did not appear to influence survival. This study documented an increase in TC incidence in FVG in the last decade, with overdiagnosis accounting for a large proportion of TC diagnoses and total thyroidectomy in more than 80% of cases. These findings suggest reconsidering thyroid screening practice and aggressive therapeutic strategies, as recommended by new TC guidelines.

Understanding Pathways to the Diagnosis of Thyroid Cancer: Are There Ways We Can Reduce Over-Diagnosis?

The incidence of thyroid cancer has rapidly increased, and ecological evidence suggests this is due in some part to over-diagnosis. Understanding pathways to diagnosis could help determine whether unnecessary diagnosis can be avoided. A population-based sample (n = 1007) of thyroid cancer patients diagnosed between July 2013 and August 2016 was recruited from Queensland, Australia (response rate 67%). Information from structured telephone interviews was used to describe diagnostic pathways for thyroid cancer, to investigate factors associated with diagnostic pathways, and to assess the most prevalent modes of diagnoses by which the lowest-risk, potentially over-diagnosed thyroid cancers (intrathyroidal microcarcinomas) are detected. Only 38% of participants presented with symptoms potentially related to thyroid cancer. Older age at diagnosis was associated with a lower prevalence of symptomatic diagnosis (prevalence ratio [PR] = 0.46 [confidence interval (CI) 0.31-0.68] for 70-79 vs. <30 years), as was frequent medical contact, while living in rural/regional areas was associated with a higher prevalence of symptomatic diagnosis (PR = 1.17 [CI 1.00-1.37] for rural/regional areas vs. major cities). Symptomatic diagnosis also occurred more for those whose tumors had adverse histopathological features (larger size, lymph node involvement, lymphovascular invasion). The likelihood of diagnosis of intrathyroidal microcarcinomas was greatest for those having surgical resection or monitoring for benign thyroid disease (PR = 3.87 [CI 2.81-5.32] and PR = 2.21 [CI 1.53-3.18], respectively). A minority of newly detected thyroid cancer cases were diagnosed because of symptoms. Access to medical care and factors related to cancer aggressiveness were associated with how diagnoses occurred. The likelihood of diagnosing the lowest-risk thyroid cancers was higher in situations related to management of other thyroid conditions. Adherence to thyroid management guidelines could reduce some thyroid cancer over-diagnosis, but ultimately better diagnostic tools are needed to differentiate between indolent cancers and those of clinical significance.

A pilot study examining Toronto-area family physician perspectives on thyroid neoplasm evaluation

ObjectiveThe incidence of thyroid cancer (TC) is known to be very high in the Greater Toronto Area of Ontario, Canada. We performed a pilot survey study examining Toronto-area family physician (FP) perspectives on thyroid neoplasm evaluation (i.e. thyroid nodules [TNs] or thyroid cancer [TC]) in this region, to explore for potential factors leading to overdiagnosis.MethodsWe performed a cross-sectional mail-out written survey of a random sample of 300 FPs in active practice in the Greater Toronto Area (Markham and Brampton).ResultsThe overall response rate was 22.3, 95% confidence interval (CI) 18.0, 27.4% (67/300); the effective response rate was 19.9, 95% CI 15.7, 24.9% (58/291), after excluding 6 FPs that reported TN evaluation was outside their scope of practice and three FPs with an invalid mailing address. There were no missing responses to questions. The demographic characteristics were as follows: 58.6% (34/58) from Markham, 55.2% (32/58) were female, 58.6% (34/58) were in practice > 10 years, and 32.8% (19/58) affiliated with a University. All FPs reported easy access to thyroid ultrasound (TUS). About half of FPs were concerned about overdiagnosis of TC and most did not believe that there was any TC survival advantage with routine screening TUS. Although appropriate indications for TUS were endorsed by most respondents (e.g. palpable TN, incidental TN on other imaging), inappropriate recommendations were observed in a third of FPs (19/57) who recommended TUS for abnormal thyroid blood tests about half of FPs (30/56) who endorsed biopsy of sub-centimeter nodules. About half of FPs (31/58) reported that their patients sometimes request medically unnecessary TUS.ConclusionThere are likely multiple complex factors leading to potential overdiagnosis of TC in primary care, including some physicians’ knowledge gaps about appropriate indications for TN investigations as well as patients’ requests and expectations.

In Brief

In Brief

Active surveillance for very low-risk papillary thyroid carcinoma: experience and perspectives from Japan

Low-risk papillary thyroid carcinoma (PTC) has been treated using lobectomy in Japan. This represents a very different approach to that used in Western countries, where the majority of patients have been treated with total thyroidectomy followed by radioactive iodine (RAI). Given the excellent survival and lower risk of surgical complications, Western guidelines have recently adopted a limited surgical approach for low-risk PTC. The treatment paradigm has shifted from a one-size-fits-all approach to more individualized protocols under the concept of risk-adapted management and treatment policies in the East and West have become increasingly integrated. The incidence of thyroid cancer has continued increasing around the world, mainly thanks to the increased detection of small PTCs, and debate is now emerging regarding the potential for overdiagnosis and overtreatment of subclinical thyroid cancers. Countermeasures to the phenomenon have been explored. Guidelines have been establishing new standards for cancer screening and clinical diagnosis. Pathologists have proposed changing the diagnostic criteria and terminology for indolent thyroid tumors. Since the 1990s, two Japanese institutions have initiated prospective trials of active surveillance for asymptomatic papillary microcarcinoma (PMC). These trials verified that the vast majority of tumors did not progress during active surveillance and outcomes were unaffected by delaying surgery. The Japanese guidelines adopted active surveillance management for asymptomatic PMC in 2010. The 2015 American Thyroid Association (ATA) guidelines have accepted the policy as an alternative to immediate surgery in patients with very low-risk tumors. Further studies have revealed that PMC was less progressive in older patients than in younger patients. Strong calcification and poor vascularity were indicators of stable disease. Several clinical issues remain unsolved in terms of active surveillance options for very low-risk PTC. Studies on patient-reported outcomes are still lacking and more specific predictors for the progression of low-risk PTC at the time of diagnosis are in demand.

Effect of a Change in Papillary Thyroid Cancer Terminology on Anxiety Levels and Treatment Preferences

Given evidence of overdiagnosis and overtreatment of small papillary thyroid cancers (PTCs), strategies are needed to promote the consideration of less invasive treatment options for patients with low-risk PTC. To determine the association of treatment preferences and anxiety levels for PTC with the terminology used to describe the condition. This randomized crossover study involved a community sample of 550 Australian men and women 18 years or older without a history of thyroid cancer. Between March 16, 2016, and July 26, 2016, participants accessed an online study that presented 3 hypothetical but clinically realistic scenarios, each of which described PTC as papillary thyroid cancer, papillary lesion, or abnormal cells. Participants were exposed to all 3 scenarios with the different terminologies, and participants were randomized by the order (first, second, or third) in which they viewed the terminologies. Data analysis was conducted from September 1, 2016, to May 15, 2017. Treatment choice (total thyroidectomy, hemithyroidectomy, or active surveillance), diagnosis anxiety, and treatment choice anxiety. Of the 550 participants who completed the online study and were included in the analysis, 279 (50.7%) were female and the mean (SD) age was 49.9 (15.2) years. A higher proportion of participants (108 [19.6%]) chose total thyroidectomy when papillary thyroid cancer was used to describe the condition compared with the percentage of participants who chose total thyroidectomy when papillary lesion (58 [10.5%]) or abnormal cells (60 [10.9%]) terminology was used. At first exposure, the papillary thyroid cancer terminology led 60 of 186 participants (32.3%) to choose surgery compared with 46 of 191 participants (24.1%) who chose surgery after being exposed to papillary lesion terminology first (risk ratio [RR], 0.73; 95% CI, 0.53-1.02) and 47 of 173 participants (27.2%) after being exposed to abnormal cells (RR, 0.82; 95% CI, 0.60-1.14) terminology first. After the first exposure, participants who viewed papillary thyroid cancer terminology reported significantly higher levels of anxiety (mean, 7.8 of 11 points) compared with those who viewed the papillary lesion (mean, 7.0 of 11 points; mean difference, -0.8; 95% CI, -1.3 to -0.3) or abnormal cells (mean, 7.3 of 11 points; mean difference, -0.5; 95% CI, -1.0 to 0.01). Overall, interest in active surveillance was high and higher levels of anxiety were reported by those who chose surgery, regardless of which terminology was viewed first (mean difference, 1.5; 95% CI, 1.0-1.9). Changing the terminology of small PTCs may be one strategy to reduce patients' anxiety levels and help them consider less invasive management options. To curtail overdiagnosis and overtreatment in PTC, other strategies may include providing balanced information about the risks and advantages of alternative treatments. anzctr.org.au Identifier: ACTRN12616000271404.

Association of Preferences for Papillary Thyroid Cancer Treatment With Disease Terminology

ImportanceGiven recent evidence of overdiagnosis and overtreatment of small papillary thyroid cancers (PTCs) and other low-risk cancers, strategies are needed to help patients consider less invasive treatment options.ObjectivesTo determine which factors influence treatment preferences for patients with PTC, and the trade-offs in treatment factors people are willing to accept, and to understand how terminology influences preferences and benefit-harm trade-offs.Design, Setting, and ParticipantsPreferences in PTC treatment were evaluated using a discrete choice experiment (DCE) conducted as a web-based survey using an existing public online research panel. Participants were randomized to receive 1 of 2 frames of information based on the terminology used to describe the condition: “cancer” or “lesion.” Participants chose between 3 treatment options for PTC (thyroidectomy, hemithyroidectomy, and active surveillance). Analyses were conducted using a mixed logit model.Main Outcomes and MeasuresThe main outcome variable was treatment preference; attributes of treatment options and sociodemographic characteristics were explanatory variables.ResultsThe DCE was completed by 2054 participants (993 [48.3%] men and 1061 [51.7%] women; mean [SD] age, 46.0 [16.5] years) with no history of thyroid cancer. Participants preferred options with less frequent follow-up, lower out-of-pocket costs, lower chances of having voice and calcium level problems, and a lower risk of developing invasive thyroid cancer and of dying of thyroid cancer. When trading benefits against harms, participants were willing to accept a higher number of extra patients experiencing adverse effects to avoid a thyroid cancer death when the condition was described as a cancer compared with a lesion. Specifically, participants for whom the condition was described as a cancer were willing to accept more patients requiring lifelong medication (mean, 273; 95% CI, 207-339 vs mean, 98; 95% CI, 66-131), experiencing calcium problems (mean, 110; 95% CI, 77-144 vs mean, 56; 95% CI, 55-58), and fatigue (mean, 958; 95% CI, 691-1224 vs mean, 469; 95% CI, 375-564). For both the cancer and lesion terminology, health literacy consistently was associated with preferences for treatment options. Those with lower health literacy had a significantly lower preference for less invasive treatment options.Conclusions and RelevanceThis study makes an important contribution to understanding how attributes of treatment options, terminology, and patient characteristics, in particular health literacy, influence treatment decision making for PTC. As a result of increasing evidence of the indolent nature of PTC and other low-risk cancers, strategies to deal with potential overtreatment are critically needed.Trial RegistrationAustralian New Zealand Clinical Trials Registry: ACTRN12617000066381

Cost effectiveness of immediate biopsy versus surveillance of intermediate-suspicion thyroid nodules

BackgroundIn an effort to reduce overdiagnosis of low-risk thyroid cancer, recent clinical guidelines increased the size-based biopsy thresholds for thyroid nodules. The cost-effectiveness of these guidelines is largely unknown. We hypothesized that ultrasound surveillance in lieu of immediate fine needle aspiration biopsy would be cost effective for a 1.0 cm thyroid nodule with American Thyroid Association Intermediate Suspicion sonographic features. MethodsA Markov transition-state model was constructed to compare immediate fine needle aspiration versus ultrasound surveillance. Univariate and multivariate sensitivity analyses were used to examine the uncertainty of cost, probability, and utility estimates in the model. ResultsUltrasound surveillance was $1,829 less costly and 0.016 quality-adjusted life years more effective than immediate fine needle aspiration. Immediate fine needle aspiration became cost effective when the probability of malignancy increased from 15% to 84% or the cost of ultrasound increased from $129 to $793. Immediate fine needle aspiration was cost-effective if the quality adjustment factor for observation following a benign fine needle aspiration result exceeded the quality adjustment factor for observation without a biopsy. ConclusionUltrasound surveillance is more cost-effective than immediate fine needle aspiration for 1.0 cm thyroid nodules with an intermediate-suspicion sonographic pattern. Additional investigation of health-related quality of life in patients undergoing fine needle aspiration or surveillance is necessary.

The impact of overdiagnosis on thyroid cancer epidemic in Italy,1998–2012

AimsIn Italy, incidence rates of thyroid cancer (TC) are among the highest worldwide with substantial intracountry heterogeneity. The aim of the study was to examine time trends of TC incidence in Italy and to estimate the proportion of TC cases potentially attributable to overdiagnosis. MethodsData on TC cases reported to Italian cancer registries during 1998–2012 aged <85 years were included. Age-standardised incidence rates (ASR) were computed by sex, period, and histology. TC overdiagnosis was estimated by sex, period, age, and Italian region. ResultsIn Italy between 1998–2002 and 2008–2012, TC ASR increased of 74% in women (from 16.2 to 28.2/100,000) and of 90% in men (from 5.3 to 10.1/100,000). ASR increases were nearly exclusively due to papillary TC (+91% in women, +120% in men). In both sexes, more than three-fold differences emerged between regions with highest and lowest ASR. Among TC cases diagnosed in 1998–2012 in Italy, we estimated that overdiagnosis accounted for 75% of cases in women and 63% in men and increased over the study period leading to overdiagnosis of 79% in women and 67% in men in 2008–2012. Notably, overdiagnosis was over 80% among women aged <55 years, and substantial variations were documented across Italian regions, in both genders. Conclusion(s)Incidence rates of TC are steadily increasing in Italy and largely due to overdiagnosis. These findings call for an update of thyroid gland examination practices in the asymptomatic general population, at national and regional levels.

Ethical issues raised by thyroid cancer overdiagnosis: A matter for public health?

Current practices of identifying and treating small indolent thyroid cancers constitute an important but in some ways unusual form of overdiagnosis. Overdiagnosis refers to diagnoses that generally harm rather than benefit patients, primarily because the diagnosed condition is not a harmful form of disease. Patients who are overdiagnosed with thyroid cancer are harmed by the psycho-social impact of a cancer diagnosis, as well as treatment interventions such partial or total thyroidectomy, lifelong thyroid replacement hormone, monitoring, surgical complications and other side effects. These harms seem to outweigh any putative benefit of knowing about a cancer that would not have caused problems if left undiscovered. In addition to harms to patients, thyroid cancer overdiagnosis leads to significant opportunity costs at a societal level, due to costs of diagnosis and treatment. Unlike many other overdiagnosed cancers, accurate risk stratification is possible with thyroid cancer. At the individual patient level, use of this risk information might support informed choice and/or shared decision-making, as mandated by clinical ethics frameworks. And this approach might, to some extent, help to reduce rates of diagnosis and intervention. In practice, however, it is unlikely to stem the rising incidence and associated harms and costs of overdiagnosed thyroid cancer, especially in situations where health professionals have conflicts of interest. We argue in this article that thyroid cancer overdiagnosis may be usefully understood as a public health problem, and that some public health approaches will be readily justifiable and are more likely to be effective in minimising its harms.

Can Thyroid Cancer Overdiagnosis, Overtreatment, and Costs Be Reduced by Following Guidelines?

Can Thyroid Cancer Overdiagnosis, Overtreatment, and Costs Be Reduced by Following Guidelines?

Overdiagnosis and overtreatment of thyroid cancer: A population-based temporal trend study.

BackgroundThe increase in incidence of thyroid cancer during the last decades without concomitant rise in mortality may reflect the growing detection of indolent forms of thyroid cancer, and may have fueled unnecessary thyroidectomies. Our aim was therefore, to compare recent secular trends in surgical intervention rate for thyroid cancer with the incidence and mortality of thyroid cancer to assess overdiagnosis and resulting overtreatment.MethodsWe conducted a population-based temporal trend study in Switzerland from 1998 to 2012. All cases of invasive thyroid cancer, deaths from thyroid cancer, and cancer-related thyroidectomies were analyzed. We calculated changes in age-standardized thyroid cancer incidence rates, stratified by histologic subtype and tumor stage, thyroid cancer-specific mortality, and thyroidectomy rates.ResultsBetween 1998 and 2012, the age-standardized annual incidence of thyroid cancer increased from 5.9 to 11.7 cases/100,000 among women (annual mean absolute increase: +0.43/100,000/year) and from 2.7 to 3.9 cases/100,000 among men (+0.11/100,000/year). The increase was limited to the papillary subtype, the most indolent form of thyroid cancer. The incidence of early stages increased sharply, the incidence of advanced stages increased marginally, and the mortality from thyroid cancer decreased slightly. There was a three- to four-fold increase in the age-standardized annual thyroidectomy rate in both sexes.ConclusionsWe observed a large increase in the incidence of thyroid cancer, limited to papillary and early stage tumors, with a three- to four-fold parallel increase in thyroidectomy. The mortality slightly decreased. These findings suggest that a substantial and growing part of the detected thyroid cancers are overdiagnosed and overtreated.ImpactTargeted screening and diagnostic strategies are warranted to avoid overdetection and unnecessary treatment of thyroid cancers.

Methylation markers differentiate thyroid cancer from benign nodules.

The incidence of thyroid cancer (TC) is increasing. Cytology by itself cannot distinguish TC from some benign nodules especially in certain subtypes of TC. Our immediate goal is to identify DNA methylation markers for early detection of TC and to molecularly differentiate TC subtypes from benign nodules. Promoter methylation status of 21 candidate genes was examined on formalin-fixed paraffin-embedded tissue (FFPE) utilizing quantitative methylation-specific polymerase chain reaction (QMSP) in a retrospective cohort of 329 patients (56% white, 29% African American, 61% female) comprising 71 normal thyroid, 83 benign nodules [follicular adenomas (FA)], 90 follicular TC (FTC) and 85 papillary TC (PTC). All genes were analyzed individually (Kruskal-Wallis and Wilcoxon rank sum tests) and in combination (logistic regression models) to identify genes whose methylation levels might best separate groups. Combination gene panels TPO and UCHL1 (ROC=0.607, sensitivity 78%) discriminated FTC from FA, and RASSF1 and TPO (ROC=0.881, sensitivity 78%) discriminated FTC from normal. Methylation of TSHR distinguished PTC from FTC (ROC=0.701, sensitivity 84%) and PTC from FA (ROC=0.685, sensitivity 70%). The six gene panel of TIMP3, RARB2, SERPINB5, RASSF1, TPO and TSHR, which differentiates PTC from normal thyroid, had the best combination sensitivity (91%) and specificity (81%) of the panels addressing discrimination of cancer tissue. Aberrant gene methylation used in combination panels may be useful clinically in differentiating FTC and PTC from benign nodules. If confirmed in additional studies, these findings could help reduce the over diagnosis of thyroid cancer and surgeries related to over diagnosis.

Clinical features and results of laboratory and instrumental examination of&#x0D; patients with nodular structures in the thyroid gland in real clinical practice

The ever increasing incidence of thyroid cancer throughout the world poses the problem of differential diagnosis of thyroid nodules at various stages of their formation. Objective: to determine the most important clinical, laboratory and instrumental parameters of thyroid nodules for the assessment of their malignancy potential and to identify "defects" of clinical and instrumental examination of patients with nodular goiter in clinical practice. Materials and methods: we analyzed the data of general clinical research, hormonal profile, and thyroid ultrasound studies performed on the basis of various clinics in the city of Tomsk (41%), Endocrinology Department of the OGAUZ TOKB consultative and diagnostic polyclinic (28 %), and Cancer Research Institute (31%) for the period from 2012 to 2014. The patients were selected for surgery. Pre-operative data were compared with histological features of the nodules. Results: we analyzed «defects» of patient examination, statistical data on clinical and laboratory-instrumental parameters of thyroid nodules. Conclusion: «defects» of description of ultrasound data significantly reduce sensitivity of the method for predicting malignancy of thyroid nodules. The description of the material obtained by US-FNA alone, in the absence of the conclusion of medical cytologists, has no informative value. Low specificity of a cytological study (48.4%) and its high sensitivity (95.8%) suggests overdiagnosis of thyroid cancer.

Thyroid fine-needle aspiration biopsy positively correlates with increased diagnosis of thyroid cancer in South Korean patients

BackgroundThe incidence of thyroid cancer among South Koreans is more than 10-fold greater than its incidence in other countries, although its associated mortality rate is similar. Amidst concerns regarding the over-diagnosis of thyroid cancer related to gradually expanded medical testing in South Korea, we hypothesized that the number of thyroid fine-needle aspiration biopsies has led to increased diagnosis of thyroid cancer.MethodsWe used data from the National Health Insurance Service National Sample Cohort 2003–2013, which included all medical claims filed for the 1,122,456 people in a nationally representative sample. We performed a Poisson regression analysis using generalized estimating equation to investigate the relationship between the number of thyroid fine-needle aspiration biopsies and the newly diagnosed cases of thyroid cancer.ResultsThe study included 60 annual patients per 100,000 individuals out of 11,024,548 person-years. The number of biopsies per 100,000 patients positively correlated with increased incidence of thyroid cancer diagnosis (per 100 biopsy cases: RR = 1.108; 95% CI: 1.090–1.126; P < 0.0001). Such relationships were greater in males, patients with a higher socioeconomic status, and patients from regions with relatively less accessibility to biopsies.ConclusionOur findings suggest that a higher number of thyroid fine-needle aspiration biopsies per 100,000 individuals in a specific Si-Gun-Gu is positively associated with excessively increased diagnosis of thyroid cancer. Regarding the continually increasing thyroid cancer incidence in South Korea, healthcare professionals and policy makers should consider proper guidelines for recognizing the role of thyroid fine-needle aspiration biopsies in the potential over-diagnosis of thyroid cancer.

Thyroid cancer: Overdiagnosis of papillary carcinoma - who benefits?

Thyroid cancer overdiagnosis is a worldwide phenomenon. Nowhere else in the world is the incidence of thyroid cancer growing faster than in South Korea, but what are the drivers, consequences and response to this threat — in short, who benefits from thyroid cancer diagnosis?

Thyroid Cancer Overdiagnosis Is a Result of Screening Programs in South Korea

Clinical ThyroidologyVol. 29, No. 1 SummariesThyroid Cancer Overdiagnosis Is a Result of Screening Programs in South KoreaElizabeth N. PearceElizabeth N. PearceSearch for more papers by this authorPublished Online:1 Jan 2017https://doi.org/10.1089/ct.2017;29.8-10AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View articleFiguresReferencesRelatedDetailsCited byAn Update on the Risk of Lymph Node Metastasis for the Follicular Variant of Papillary Thyroid Carcinoma with the New Diagnostic Paradigm24 June 2017 | Head and Neck Pathology, Vol. 12, No. 1The Increased Incidence of Thyroid Cancer Is Worldwide Jerome M. Hershman1 January 2017 | Clinical Thyroidology, Vol. 29, No. 1 Volume 29Issue 1Jan 2017 InformationCopyright 2017 American Thyroid Association, Inc.To cite this article:Elizabeth N. Pearce.Thyroid Cancer Overdiagnosis Is a Result of Screening Programs in South Korea.Clinical Thyroidology.Jan 2017.8-10.http://doi.org/10.1089/ct.2017;29.8-10Published in Volume: 29 Issue 1: January 1, 2017PDF download

Breast, prostate, and thyroid cancer screening tests and overdiagnosis

The purpose of this study was to examine overdiagnosis and overtreatment related to cancer screening and to review relevant reports and studies. A comprehensive search of peer-reviewed and gray literature was conducted for relevant studies published between January 2000 and December 2015 reporting breast, prostate, and thyroid cancer screening tests and overdiagnosis. This study revealed no dichotomy on where screening would lower risk or cause overdiagnosis and overtreatment. Many screening tests did both, that is, at population level, there were both benefit (decreased disease-specific mortality) and harm (overdiagnosis and overtreatment). Therefore, we need to consider a balanced argument with citations for the potential benefits of screening along with the harms associated with screening. Although the benefits and harms can only be tested through randomized trials, important data from cohort studies, diagnostic accuracy studies, and modeling work can help define the extent of benefits and harms in the population. The health care cycle that prompt patients to undergo periodic screening tests is self-reinforcing. In most developed countries, screening test recommendations encourage periodic testing. Therefore, patients are continuing their screening. It is necessary for patients to become wise consumers of screening tests and make decisions with their physicians regarding further testing and treatments.