To the Editor We read with interest the article by Qian et al,1 who reported thyroid cancer incidence among children in the United States. On the basis of similar trends between tumor sizes (0.1-2.0 and >2 cm) and between extent of diseases (localized and regional), they suggested 2 causes of the increase: overdiagnosis, associated with a 2006 recommendation for a similar diagnostic and therapeutic approach in children as in adults by the American Thyroid Association; and environmental risk factors, such as increased exposure to medical radiation. The increase in large-tumor (>2 cm) thyroid cancer is not evidence of a true increase, as ultrasonographic screening of young patients with limited radiation exposure within 3 years after the Fukushima nuclear accident showed that the growth of large-tumor (as large as 5 cm) thyroid cancer was arrested.2 The increase in regional extended thyroid cancer also does not prove a true increase because of a similar prognosis in adolescents and young adults.3 Further investigations are warranted to assess associations between thyroid cancer incidence and the number of people screened by sensitive imaging or the rates of fine-needle aspiration biopsies.
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Murakami M, Midorikawa S, Ohtsuru A. Harms of Pediatric Thyroid Cancer Overdiagnosis. JAMA Otolaryngol Head Neck Surg. 2020;146(1):84. doi:10.1001/jamaoto.2019.3051
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