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Thyroid cancer: “not an epidemic of disease but an epidemic of diagnosis”

A paper in the journal JAMA Otolaryngology – Head & Neck Surgery, “Current Thyroid Cancer Trends in the United States,” addresses overdiagnosis of thyroid cancer.  The authors report a tripling of incidence over the past 40 years, but a stable death rate.  The authors write that nearly all of the increase was in less aggressive or small tumors that may never cause harm:

“…it is not an epidemic of disease but rather an epidemic of diagnosis. ..

We also expressed the fear that the problem of overdiagnosis might get worse. Thyroid cancer has been long recognized to be a common autopsy finding, despite never having caused symptoms during a patient’s life. Thyroid nodules are extraordinarily common and frequently detected by physical examination of the neck and even more frequently by imaging. If increased diagnostic scrutiny is added to this mix—more thyroid palpation or more imaging—overdiagnosis will increase.”

Below is a video of a talk given by one of the authors, Dartmouth’s Dr. Gil Welch.  To the right is an ad he discusses at about 47:47 deep – an ad for a thyroid cancer awareness campaign that used the slogan, “Confidence Kills,” with a message that thyroid cancer doesn’t care how healthy you are.  Welch said, “What a horrible message: If you feel good about yourself, something is wrong with you.”   Recently, a pancreatic cancer awareness ad campaign drew a lot of criticism.  I think this entire field of advocacy/awareness campaigns deserves more scrutiny, as it is often guilty of fear-mongering, whipping the worried well into a frenzy, and becoming the health care equivalent of the search for weapons of mass destruction – if we haven’t found anything yet, it’s because we haven’t looked hard enough.


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