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July 3, 1954


JAMA. 1954;155(10):928. doi:10.1001/jama.1954.03690280052019

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To the Editor:  —I am dismayed at the inconsistencies in the article in The Journal, April 17, 1954, page 1321, by Joseph Sokal concerning the incidence of malignancy in toxic and nontoxic nodular goiter. On page 1322 is the statement that "Thyroid nodules are premalignant lesions." This is the accepted opinion of the majority interested in thyroid disease, and because of this fact surgical removal is advised. Yet in the summary on page 1325, it is stated: "The risk of cancer is small in all types of goiter. About 1% of toxic nodular goiters are malignant. The incidence of cancer among unselected nontoxic... goiter is probably less than 0.2%." The inference here is that one need not worry that cancer will arise in goiter because the estimate of the author is so low. Yet the fallacy of this reasoning and the false sense of security it engenders is adequately borne

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