Screening for Thyroid Cancer

Abstract

he US Preventive Services Task Force (USPSTF) makes recommendations about the effectiveness of specific preventive care services for patients without obvious related signs or symptoms.It bases its recommendations on the evidence of both the benefits and harms of the service and an assessment of the balance. The USPSTF does not consider the costs of providing a service in this assessment.The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision making to the specific patient or situation. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms. Summary of Recommendation and EvidenceThe USPSTF recommends against screening for thyroid cancer in asymptomatic adults (D recommendation) (Figure 1). Rationale ImportanceIn 2013, the incidence rate of thyroid cancer in the United States was 15.3 cases per 100 000 persons, which represents a significant increase from 1975, when the incidence rate was 4.9 cases per 100 000 persons. 1 The increase in thyroid cancer incidence was 6.7% IMPORTANCE The incidence of thyroid cancer detection has increased by 4.5% per year over the last 10 years, faster than for any other cancer, but without a corresponding change in the mortality rate. In 2013, the incidence rate of thyroid cancer in the United States was 15.3 cases per 100 000 persons. Most cases of thyroid cancer have a good prognosis; the 5-year survival rate for thyroid cancer overall is 98.1%. OBJECTIVE To update the US Preventive Services Task Force (USPSTF) recommendation on screening for thyroid cancer. EVIDENCE REVIEWThe USPSTF reviewed the evidence on the benefits and harms of screening for thyroid cancer in asymptomatic adults, the diagnostic accuracy of screening (including neck palpation and ultrasound), and the benefits and harms of treatment of screen-detected thyroid cancer.FINDINGS The USPSTF found inadequate direct evidence on the benefits of screening but determined that the magnitude of the overall benefits of screening and treatment can be bounded as no greater than small, given the relative rarity of thyroid cancer, the apparent lack of difference in outcomes between patients who are treated vs monitored (for the most common tumor types), and observational evidence showing no change in mortality over time after introduction of a mass screening program. The USPSTF found inadequate direct evidence on the harms of screening but determined that the overall magnitude of the harms of screening and treatment can be bounded as at least moderate, given adequate evidence of harms of treatment and indirect evidence that overdiagnosis and overtreatment are likely to be substantial with population-based screening. The USPSTF therefore determined that the net benefit of screening for thyroid cancer is negative. CONCLUSIONS AND RECOMMENDATIONThe USPSTF recommends against screening for thyroid cancer in asymptomatic adults. (D recomme...

Increased cardiovascular risk in thyroid cancer patients taking levothyroxine: a nationwide cohort study in Korea

“…Consistent with previous studies (10, 11), we report an increased incidence of CHD and ischemic stroke among thyroid cancer patients compared to controls and showed that post-thyroidectomy levothyroxine dosage, which serves as a proxy marker for level of TSH suppression, is a key factor in such risk. Our study suggests that cardiovascular risk should be taken into consideration when the target level for TSH suppression is determined (6), and support recent recommendations that called for a more cautious approach in the screening and treatment of thyroid cancer and subsequent TSH suppression therapy (19,20). The pathophysiological mechanism for increased incidence of CHD and ischemic stroke remains largely unknown (10).…”

“…If the long-term risk of cardiovascular events revealed in our study is additionally taken into consideration, the benefits of screening and aggressive therapy would be mitigated to some degree. The US Preventive Services Task Force (USPSTF) recently recommended against screening for thyroid cancer in asymptomatic adults (20).…”

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

“…Examination of the mechanisms that drive overdiagnosis and overtreatment of thyroid cancer is urgently warranted. Due notably to the harms of overdiagnosis, the US Preventive Services Task Force has recently updated its recommendation against routine screening for thyroid cancer (D level recommendation) [38, 41]. To identify which patients could benefit from the detection of early stage cases, a risk-based screening with combined diagnostic and prognostic tools (biomarker, personalized medicine) could be a promising approach to tailor prevention and screening according to the individual risk of thyroid cancer [42].…”

Follow-up of low risk thyroid cancer patients: can we stop follow-up after 5 years of complete remission?

“…In order to limit this phenomenon, the US Preventive Services Task Force recommends against thyroid screening in the general population (4). This statement does not apply to subjects with recognized risk factors of thyroid cancer (i.e.…”