Overdiagnosis is the detection of a disease that does not do any harm to the patient throughout the lifetime. However, many of the cancers they found were small, some as small as 0. Prevalence of differentiated thyroid cancer in autopsy. Overdiagnosis is a growing issue, highlighted for example in the bmj and dr welchs thoughtprovoking book overdiagnosed. Jan 29, 2020 perhaps the most serious story of overdiagnosis is thyroid cancer. The study found that thyroid cancer incidence rates increased in canada by five and six times in men and women respectively between 1970 and 2012 with unchanged mortality rates. Second, in autopsy series, thyroid cancer can easily be found in 36% of adults, and investigators have estimated that if the slices were made thinly enough for microscopic examination they could have. Thyroid cancers overdiagnosed in canada for in 75 percent. Denver the epidemic in thyroid cancer recently reported by a number clinical journals has raised questions about overdiagnosis of. Just a reminder to say please feel free to email me if you have a thyroid cancer question that i might be able to help with. Similar upward trends for thyroid cancer are found in the united states and europe, although not to the same degree. Overdiagnosis is when an asymptomatic cancer is identified through medical technology, but the cancer is either noninvasive or so slowgrowing that it would never cause. The overdiagnosis of cancer and unnecessary chemo and radiation. The thyroid cancer rate in the united states has more than doubled since 1994.
Sep 06, 2016 purpose differentiated thyroid cancer dtc incidence has been reported to have increased three to 15fold in the past few decades. For women, the risk of thyroid cancer overdiagnosis ranges from 50% to as high as 7080% in the u. Too much screening has misled us about real cancer. Overdiagnosis of juvenile thyroid cancer fulltext european. The overdiagnosis of thyroid cancer has led to a surge in harmful treatments that dont have proven benefits for survival, according to a report. The 20 year survival rate is greater than 90%, and approaches 100% for the smallest cancers. Since ultrasounds became available in the 1970s, small thyroid growths are being increasingly discovered through imaging, often unintentionally. Revisiting overdiagnosis and fatality in thyroid cancer. Over the past few years, experts have reported an epidemic of thyroid cancer. But the focus on detecting early stage cancers is not universally positive and is leading to overdiagonosis, particulary for prostate, breast, melanoma, and thyroid cases. The occurrence of overdiagnosis is also supported by populationbased data showing an alarming rise in thyroid cancer incidence without change in mortality.
It is unclear whether this represents overdiagnosis or a true increase in incidence. Study points to overdiagnosis of thyroid cancer the new. Overdiagnosis and screening for thyroid cancer in korea. Thyroid cancer overdiagnosis raises questions about. Due to the increased incidence of thyroid cancer observed over the last 15 years and a simultaneous reduction of mortality due to thyroid cancer, there is the suspicion of overdiagnosis using. Nov 06, 2014 similar upward trends for thyroid cancer are found in the united states and europe, although not to the same degree. Thyroid cancer is one of the few cancers that has increased in. This book makes a compelling case against excessive medical screening and. Nov 30, 2016 nonlethal cancers picked up by screening are probably responsible thyroid cancer incidence has increased dramatically in many countries in the developed world over the past three decades. Gilbert welch is an american academic physician and cancer researcher. Dr toms thyroid cancer blog thyroid cancer support. Thyroid cancer fulfills the criteria for overdiagnosis by having a reservoir of indolent cancers and practice patterns leading to the diagnosis of incidental cancers from the reservoir. Experience of us patients who selfidentify as having an.
In recent years, scientific concern has increased about the overdiagnosis of cancerthe detection of small cancers that are unlikely to cause medical problems. The thyroid cancer rate in the united states has more than doubled. The korean government introduced the national cancer screening and health checkup programs in 1999. In fact, some degree of overdiagnosis in cancer early detection is probably the rule, not the exception. Thyroid cancer incidence has increased dramatically in many countries in the developed world over the past three decades. Perspective from the new england journal of medicine worldwide thyroidcancer epidemic. But thyroid cancer is rare in finland as well as in the united states. Denver the epidemic in thyroid cancer recently reported by a number clinical journals has raised questions about overdiagnosis of thyroid cancer and overtreatment of papillary. The rise of thyroid cancer by overdiagnosis american. Alum jax cole thyroid cancer epidemic of overdiagnosis. In the united states and australia, overdiagnosis accounted for about 45 percent of thyroid cancer in men over that fouryear period.
In the united states it is estimated that in 2016 approximately 64,000 new patients will be diagnosed with thyroid cancer, compared to over 240,000 patients with breast cancer and 5,000 patients with colon cancer. Thyroid cancer is a malignant tumor or growth originating. The seer database from the united states showed a threefold increase in. Rates of thyroid cancer diagnosis have tripled in the past 3 decades, but death rates from the disease have remained the same. Salvatore vaccarella, phd, and colleagues at the iarc estimate that more than 470,000 women and 90,000 men may have ben overdiagnosed with thyroid cancer in 12 highincome.
The optimal management for patients with small, lowrisk thyroid cancer is often debated. Mapping the drivers of overdiagnosis to potential solutions. It is unclear whether this represents overdiagnosis. Thyroid cancer incidence and overdiagnosis in korea thyroid cancer screening program in korea. The overdiagnosis of cancer breakaway consciousness. Thyroid cancer is a malignant tumor or growth originating within the thyroid gland. From overdiagnosis to overtreatment of lowrisk thyroid cancer. For men, the fear is not much lessened with overdiagnosis climbing to 45% in the u. Shots health news the number of people diagnosed with thyroid cancer has tripled since 1975, but more lives havent been. T he bestknown downside of cancer screening, such as psa tests for prostate cancer and mammograms for breast cancer, is that they often flag cancers that pose no risk, leading to. According to canadian cancer statistics 1, the incidence of thyroid cancer in women in canada has been increasing steadily at 7% per year since the mid2002.
Aug 11, 2016 an epidemic of overdiagnosis of thyroid cancer in women. Aug 23, 2016 the same trend applied to men, but to a lesser degree. The korean government introduced the national cancer screening and health checkup programs in 1999 ahn et al. Studies suggest that overdiagnosis of cancersincluding prostate, breast, and thyroid cancerspresents challenges to both doctors and patients. Aug 17, 2016 the american thyroid association recognizes that the recent increase in incidence of thyroid cancer in the united states and other countries is, in large part, due to the diagnosis of indolent papillary microcarcinomas that will never result in symptoms or death, and which only rarely will enlarge or spread beyond the thyroid gland. The american thyroid association recognizes that the recent increase in incidence of thyroid cancer in the united states and other countries is, in large part, due to the diagnosis of. Zealous imaging is fueling the overdiagnosis and overtreatment of subclinical lowrisk thyroid cancer in the united states, researchers warn in a new report. Thyroid cancer may be diagnosed after a person goes to a doctor because of symptoms, or it might be found during a routine physical exam or other tests. It is a disease in which cells grow abnormally and have the potential to spread to other parts of the body. Pathologists in finland examined the thyroid gland in 101 autopsies. Sep 02, 2016 the researchers concluded that the rise in ptc was attributed to overdiagnosis rather than increase in occurrence of thyroid cancer. Prognosis and survival for most carcinomas of the thyroid has long been known to be excellent. Salvatore vaccarella, phd, and colleagues at the iarc estimate that more than 470,000 women and 90,000 men may have ben overdiagnosed with thyroid cancer in 12 highincome countries australia.
Choosing no intervention for small thyroid cancers national. I cant promise to be able to help, but i promise to try. The seer database from the united states showed a threefold increase in thyroid cancer incidence from 1975 to 2010, with a relatively stable thyroid cancerspecific mortality rate. Sep 22, 2016 denver the epidemic in thyroid cancer recently reported by a number clinical journals has raised questions about overdiagnosis of thyroid cancer and overtreatment of papillary. Since ultrasounds became available in the 1970s, small. More americans are being diagnosed with thyroid cancer than ever. Confusing overdiagnosis for an epidemic of thyroid cancer. He was an internist at the veterans administration medical center in white river junction, vermont, as well as a professor of. Confusing overdiagnosis for an epidemic of thyroid. Second, in autopsy series, thyroid cancer can easily be found in 36% of adults, and investigators have estimated that if the slices were made thinly enough for microscopic examination they could have found thyroid cancer in close to 100% of adults between 5070, even though clinically apparent thyroid cancer receiving treatment only had a. Up to 80 percent of thyroid cancer cases in us are overdiagnosed. Watchful waiting reduces overdiagnosis and overtreatment of thyroid cancer among old patients.
Thyroid cancer screening and overdiagnosis in korea. Being just diagnosed with thyroid cancer, i keep telling myself to be careful with what i read online and in books as every situation is different. Therefore, the current study aimed to estimate the prevalence of incidental dtc in published autopsy series and determine whether this prevalence has been increasing over time. Overdiagnosis is a major driver of the thyroid cancer epidemic iarc. Overdiagnosis is when an asymptomatic cancer is identified through medical technology, but the cancer is either non. Jan 30, 2020 perhaps the most serious story of overdiagnosis is thyroid cancer. Making people sick in the pursuit of health 1st edition. If there is a reason to suspect you might have thyroid cancer, your doctor will use one or more tests to confirm the diagnosis. Over a third of the autopsied patients had thyroid cancers.
The same trend applied to men, but to a lesser degree. Reclassifying thyroid cancer and the willful misunderstanding. Rise in incidence of thyroid cancer blamed on overdiagnosis. Thyroid cancer support dr toms thyroid cancer blog. Shots health news the number of people diagnosed with thyroid cancer has tripled since 1975, but more lives havent been saved as a. Thyroid tumor reclassified to curb overdiagnosis of cancer. Thyroid cancer is relatively uncommon compared to other cancers. He pointed to other examples, such as thyroid cancer and melanoma, as well as others, where weve seen the incidence rates rise quickly without a concomitant decrease in mortality. Study points to overdiagnosis of thyroid cancer the new york.
Even for these small tumors, patients always have surgery as an option. Because thyroid cancer screening did not have association with a decrease in thyroid cancer mortality, the observed rise in thyroid cancer incidence has raised concerns around overdiagnosis. Thyroid cancer is cancer that develops from the tissues of the thyroid gland. Just a reminder to say please feel free to email me if you. Overdiagnosis could be behind jump in thyroid cancer cases. Jan 10, 2014 thyroid cancer fulfills the criteria for overdiagnosis, and given the increasing caseload thyroid oncologists ought to be considering the clinical relevance of some cases. Thyroid cancer overdiagnosis raises questions about overtreatment. The thyroid cancer epidemic that fizzled cbc radio. The data suggest that thyroid cancer is overdiagnosed and overtreated in.
Jan 01, 2018 t he bestknown downside of cancer screening, such as psa tests for prostate cancer and mammograms for breast cancer, is that they often flag cancers that pose no risk, leading to overdiagnosis. Books about thyroid cancer books thyroid cancer canada. Perhaps the most serious story of overdiagnosis is thyroid cancer. Thyroid cancer is overdiagnosed and overtreated, say mayo. Overdiagnosis occurs when a disease is diagnosed correctly, but the diagnosis is irrelevant. A complex web of factors has created the phenomenon of overdiagnosis. The overdiagnosis of cancer and unnecessary chemo and.
In fact, some degree of overdiagnosis in cancer early. Overdiagnosis of thyroid cancer8 is attributable to incidental detection during. So, in the meantime, if you get some bad news about a possible thyroid cancer, ask the doctor if he or she has found a thyroid lump that wont harm you and is therefore making an overdiagnosis. In the united states it is estimated that in 2016 approximately 64,000 new patients will be diagnosed with thyroid cancer, compared to. Book ask a question about dr tom blog the thyroid cancer overdiagnosis issue. However, as the number of new cases of thyroid cancers climbed, the death rate from the cancers remained stable, as other researchers reported.
More than 300 people with papillary thyroid cancer have chosen active surveillance at msk, which has allowed them to avoid. All thyroid cancers are not created equal avoiding unnecessary. Recently published data that adds to the accumulating evidence suggesting that the rapid rise in thyroid cancer represents an epidemic of diagnosis rather than disease is increasingly. Purpose differentiated thyroid cancer dtc incidence has been reported to have increased three to 15fold in the past few decades. Overdiagnosis has also been associated with early detection in a variety of other cancers, including neuroblastoma, melanoma, and thyroid cancer. Overdiagnosis of cancer conference national cancer institute. Apr 14, 2016 university of pittsburgh schools of the health sciences. Soaring diagnoses in south korea and elsewhere could be attributable to increased screening and could lead to unnecessary treatment. Rosenthal phd, is a thyroid cancer survivor who grew up in canada, and was treated for her own papillary disease in toronto in 1983 when she was 20 years old. New imaging technologies have led to the overdiagnosis of thyroid cancer, exposing thousands of people to unnecessary, costly, and potentially harmful treatments, according to a new analysis from. Back in 2012, the national cancer institute convened an expert panel to evaluate the problem of cancer s misclassification and subsequent overdiagnosis and overtreatment, determining that millions may have been wrongly diagnosed with cancer of the breast, prostate, thyroid, and lung, when in fact their conditions were likely harmless. The researchers concluded that the rise in ptc was attributed to overdiagnosis rather than increase in occurrence of thyroid cancer. Jan 01, 2014 prognosis and survival for most carcinomas of the thyroid has long been known to be excellent. We are some way off knowing how best to investigate for thyroid cancer, particularly now that its clear that harm can arise from overinvestigating.
This week ive received lots of questions from people with thyroid cancer via the website, and ive been busy replying to them as quickly as i can. Oct 22, 2018 the incidence of differentiated thyroid cancers, especially the papillary subtype, has been increasing worldwide. The potential harms of cancer overdiagnosis include not only unnecessary surgery and complications, but also the emotional and financial tribulations incurred by cancer diagnosis and indefinite followup. Although there may be a perception that overdiagnosis is limited to some prevalent cancers like prostate and breast cancer, dr. The american thyroid association recognizes that the recent increase in incidence of thyroid cancer in the united states and other countries is, in large part, due to the diagnosis of indolent papillary microcarcinomas that will never result in symptoms or death, and which only rarely will enlarge or spread beyond the thyroid gland. Choosing no intervention for small thyroid cancers. Thyroid cancer overdiagnosis in half a million patients. If the diagnosis of welldifferentiated thyroid cancer e. Basic facts thyroid cancer is the most common endocrine cancer. Increased detection due to screening results in more harm than benefit in terms of psychological stress, unnecessary surgery, and financial burden. An epidemic of overdiagnosis of thyroid cancer in women. According to dr gilbert welch in 2014 otolaryngology, there is an epidemic of overdiagnosis of thyroid cancer in young women. University of pittsburgh schools of the health sciences.