The increasing incidence of small thyroid cancers: Where are the cases coming from?

Authors

  • Louise Davies MD, MS,

    Corresponding author
    1. VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, Vermont
    2. Division of Otolaryngology , Hanover, New Hampshire
    3. Department of Community and Family Medicine , Hanover, New Hampshire
    4. Dartmouth Institute for Health Policy and Clinical Practice , Hanover, New Hampshire
    • VA Outcomes-111B, 215 North Main St., White River Junction, VT05009
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  • Michelle Ouellette BS,

    1. Dartmouth Medical School, Hanover, New Hampshire
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  • Mark Hunter MD,

    1. University of Vermont College of Medicine, Burlington, Vermont , U.S.A.
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  • H. Gilbert Welch MD, MPH

    1. VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, Vermont
    2. Department of Community and Family Medicine , Hanover, New Hampshire
    3. Dartmouth Institute for Health Policy and Clinical Practice , Hanover, New Hampshire
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  • This study was supported in part by a career development award from the Robert Wood Johnson Foundation (L.D.; Physician Faculty Scholars Program) and the Department of Veterans Affairs (L.D., H.G.W.). The authors have no other funding, financial relationships, or conflicts of interest to disclose. The views expressed do not necessarily represent the views of the Department of Veterans Affairs, the United States Government, or the Robert Wood Johnson Foundation.

  • Dr. Davies had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Abstract

Objectives/Hypothesis:

To identify the trigger events that lead to the detection of otherwise asymptomatic thyroid cancers.

Study Design:

Retrospective cohort.

Methods:

Chart abstraction of patients who underwent thyroidectomy. Iterative development of a classification algorithm to categorize trigger events.

Results:

A total of 279 thyroidectomies were performed, which resulted in 95 new diagnoses of thyroid cancer. Just less than half of identified cancers (44 cancers, 46%) were in the 127 thyroidectomies performed after identification of a thyroid abnormality by either screening or chance. A screening trigger event occurs when a physician performs a routine thyroid examination when there is no specific neck complaint. A chance trigger event can occur either by serendipity (a radiologic test done for a different reason) or by diagnostic cascade (identification of a thyroid abnormality on any test that does not plausibly explain the patient's presenting complaint). Physician screening examination was the trigger event for 49 thyroidectomies (18%). Serendipity was the trigger event for 41 thyroidectomies (15%). Diagnostic cascade was the trigger event for 33 thyroidectomies (12%). Only 75 thyroidectomies (27%) were performed because of symptoms directly referable to a neck mass, such as a patient complaint of feeling something in the neck. Forty percent received a cancer diagnosis (30 of 75 cases).

Conclusions:

Screening and chance identification were the trigger events for just less than half of both the cancers diagnosed and the thyroidectomies performed. These extra cancer diagnoses and surgeries are a significant burden for patients. These data will help direct future efforts to curb treatment of clinically unimportant thyroid nodules. Laryngoscope, 120:2446–2451, 2010

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