Rise in Incidence of Thyroid Cancer Blamed on Overdiagnosis

Laura Esserman, MD, MBA, director of the University of California at San Francisco’s Carol Franc Buck Breast Cancer Center and professor of surgery and radiology at UCSF, who coauthored a recent JAMA editorial (2013;310:797-798) on the growing issue of overdiagnosis in cancer, emphasized that better detection is not always a good thing and that the vast majority of small papillary lesions are relatively indolent. As such, she encourages physicians to call them “something less scary than thyroid cancer and to wait to intervene if there is evidence of progression. “Reassure patients,” she said. “At the end of the day, our oath is to do no harm.”

Dr. Burkey, on the other hand, sees little downside to the increased detection of smaller cancers. “There is good data to suggest that treatment of smaller and lower-stage thyroid cancers results in better survival and less extensive surgery than larger cancers,” he said.

An increasing issue in overdiagnosis is the detection of these small nodules as an incidental finding. According to Dr. Brito, in an editorial published in 2014, the incidental discovery of thyroid cancer in the United States due to the constantly increasing trend in the use of imaging, has contributed significantly to the rapid increase in thyroid cancer detection (Future Oncol. 2014;10:1-4).

According to Dr. Davies, an associate professor of surgery in the section of otolaryngology in the Geisel School of Medicine at Dartmouth College, a key message of her study is the need for better recognition of how to consider and manage these incidental small tumors. “Small, incidentally identified thyroid nodules should be recognized as such by surgeons, and an open discussion about the pros and cons of workup and surgery should be had with every patient, so they fully understand the benefits and potential harms of undergoing treatment for small, incidental, asymptomatic findings,” she said.

She also emphasized the need to revisit the threshold to biopsy small, incidentally detected thyroid nodules, saying that the threshold has likely fallen too far.

Mary Beth Nierengarten is a freelance medical writer based in Minnesota.