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JAMA Patient Page
May 9, 2017

Screening for Thyroid Cancer

JAMA. 2017;317(18):1920. doi:10.1001/jama.2017.5254

The US Preventive Services Task Force (USPSTF) has recently published updated recommendations on screening for thyroid cancer.

What Is Thyroid Cancer?

The thyroid gland sits in the middle of the neck around the windpipe. It makes a hormone called thyroid hormone, which is important for many metabolic functions. There are several different types of thyroid cancers; some are much more serious than others. The most common type is papillary thyroid cancer, which is one of the less serious types. Symptoms of thyroid cancer can include a lump on the neck, trouble breathing or swallowing, or hoarseness. Many thyroid cancers cause no symptoms. For most thyroid cancers, treatment involves surgery to remove part or all of the thyroid gland. Some cancers are also treated with radioactive iodine therapy, external beam radiation, or chemotherapy.

What Tests Are Used to Screen for Thyroid Cancer?

Screening for thyroid cancer can be done by feeling the neck for nodules (abnormal lumps) as part of a routine checkup. However, this technique has proven to not be very accurate. A more accurate way to look for nodules in the thyroid gland that could be cancer is by using a thyroid ultrasound.

What Is the Patient Population Under Consideration for Screening for Thyroid Cancer?

The USPSTF recommendation applies to adults who do not have any symptoms of thyroid cancer. It does not apply to people with a high risk of thyroid cancer, such as those who were exposed to radiation to the head or neck in the past.

What Are the Potential Benefits and Harms of Screening for Thyroid Cancer?

There are currently no studies directly looking at the benefit of finding and treating thyroid cancer in people with no symptoms. The potential benefit of screening is earlier treatment. However, it is unclear whether treating early-stage low-risk thyroid cancers with surgery with or without radioactive iodine therapy is better than just monitoring the cancer. There have been some studies showing that while the rate of thyroid cancer is going up, mortality remains stable. The best study done on this was from South Korea, which started a cancer screening program in the 1990s. As a result, from 1993 to 2011, the rate of diagnosis of thyroid cancer in South Korea went up 15-fold, but the rate of death from thyroid cancer was the same. This suggests that finding and treating more cancers via screening is not necessarily beneficial (the concept of overdiagnosis). Potential harms of screening are related to the risks of biopsy (fine needle aspiration) as well as the potentially serious side effects of neck surgery and radioactive iodine therapy.

How Strong Is the Recommendation to Screen for Thyroid Cancer?

Based on the current evidence, the USPSTF has concluded with moderate certainty that there is no net benefit to screening for thyroid cancer.

Bottom Line: Current Recommendation for Screening for Thyroid Cancer

The USPSTF recommends against screening for thyroid cancer in adults who do not have symptoms (a “D” recommendation).

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Article Information

Source: US Preventive Services Task Force. Screening for thyroid cancer: US Preventive Services Task Force recommendation statement. JAMA. doi:10.1001/jama.2017.4011

Topic: Preventive Medicine