The incidence of thyroid cancer in the United States has tripled in the past 30 years and the incidence of thyroid cancer detection has increased by 4.5% each year during the past decade, faster than for any other cancer. However, there has not been a corresponding change in the mortality rate. Dr. Juan Brito, Assistant Professor of Medicine, Division of Endocrinology at Mayo Clinic, notes, “There are two factors driving the over-diagnosis of thyroid cancer. One is new and increased use of imaging techniques that expose the thyroid gland and find thyroid cancer as an incidental finding, and the other is neck palpation in asymptomatic patients.”
According to new recommendations from the US Preventive Services Task Force (USPSTF), routine screening for thyroid cancer is not recommended. This recommendation applies only to screening asymptomatic adults and does not include individuals who may be at an increased risk for thyroid cancer due to a history of radiation exposure, inherited genetic syndromes associated with thyroid cancer, or a history of the disease. “People who are treated for small or slow-growing tumors are exposed to risks from surgery or radiation, but do not receive any benefit because the tumors are unlikely to affect the person’s health during their lifetime,” says Kristen Bibbins-Domingo, PhD, MD, MAS. Although the recommendation opposes screening of asymptomatic individuals, it is unclear what effect it may have on clinical practice. Dr. Neil Hockstein, Director of Head and Neck Multidisciplinary Center at the Helen F. Graham Cancer Center and Research Institute explains that the new USPSTF recommendation will affect the rate of thyroid cancer diagnosis and over-diagnosis only if clinicians stop screening with palpation. Dr. Hockstein says, “The USPSTF recommendations make sense except that palpation of the neck is part of a routine exam.”
The Thyroid Cancer Care Collaborative (TCCC) aims to keep both physicians and patients up to date on the latest recommendations and guidelines relating to thyroid health. The TCCC’s vision is to advance the quality of thyroid care to its highest level, and reporting on current recommendations for thyroid surveillance and treatment helps achieve this.