USPSTF recommends against thyroid cancer screening

The U.S. Preventive Services Task Force announced it is recommending against screening for thyroid cancer in asymptomatic adults.

The grade D recommendation was based on a review of 67 studies involving 583,914 patients.

According to a press release, the incidence of thyroid cancer detection has increased by 4.5% per year over the last decade, which is faster than for any other cancer. However, the mortality rate from thyroid cancer has not changed substantially. In addition, in 2013, the incidence rate of thyroid cancer in the United States was 15.3 cases per 100,000 persons, up from 4.9 cases per 100,000 persons in 1975. The 5-year survival rate for thyroid cancer overall is 98.1%.

“Although ultrasonography of the neck using high-risk sonographic characteristics plus follow-up cytology from fine-needle aspiration can identify thyroid cancers, it is unclear if population-based or targeted screening can decrease mortality rates or improve important patient health outcomes,” Jennifer S. Lin, MD, MCR, Kaiser Permanente Center for Health Research, Portland, Oregon, and colleagues wrote. “Screening that results in the identification of indolent thyroid cancers, and treatment of these overdiagnosed cancers, may increase the risk of patient harms.”

The AAFP currently recommends against screening for thyroid cancer using neck palpation or ultrasound in persons who are asymptomatic, USPSTF chair Kirsten Bibbins-Domingo, MD, and colleagues wrote, adding that the previous USPSTF recommendations regarding thyroid cancer mirrored the Academy’s.

The USPSTF stated that the recommendation does not apply to those persons with a first-degree relative with a history of thyroid cancer; persons with difficulty swallowing, pain, hoarseness, or other throat symptoms; persons who have lumps, swelling, asymmetry of the neck, or other reasons for a neck examination; persons at increased risk for thyroid cancer because of a history of exposure to ionizing radiation (such as that from medical treatment or radiation fallout); and particularly persons with a diet low in iodine or an inherited genetic syndrome associated with thyroid cancer (such as familial adenomatous polyposis).

In a related editorial, Anne R. Cappola, MD, division of endocrinology, diabetes and metabolism, department of medicine, University of Pennsylvania, said new technologies need to be developed to lower the 2,000 deaths that are attributable to thyroid cancer each year, and such technologies could lead to a different USPSTF recommendation next time.

“Even if there is no improvement in the current screening standard, thyroid ultrasonography, improvements in understanding what is happening inside the thyroid nodule are required,” she wrote. “What the field needs to prevent a similar evaluation and recommendation in the next USPSTF assessment is a noninvasive measure, either radiographic or by biomarker, to distinguish between nodules that have thyroid cells that will leave the capsule and cause morbidity and those nodules that do not. Using the same tools — palpation, ultrasound imaging, and findings on microscopic examination — is unlikely to result in a different conclusion about screening for thyroid cancer in the future.” – by Janel Miller

References:

Bibbins-Domingo K, et al. JAMA. 2017;doi:10.1001/jama.2017.4011.

Cappola AR. JAMA. 2017;doi:10.1001/jama.2017.4068.

Lin JS, et al. JAMA. 2017;doi:10.1001/jama.2017.0562.

Disclosure: The researchers report no relevant financial disclosures.