Guidelines, physicians: No symptoms should mean no screening
With the implications of overdiagnosis ranging from physical, psychological in terms of the patient, and significant personal as well as societal costs, most international guidelines explicitly recommend against screening asymptomatic individuals and call for active surveillance of microcarcinomas that are detected.
The messaging appears to be making a difference.
As reported in research by American authors discussing the thyroid cancer epidemic from a 2017 perspective, the overdiagnosis situation in South Korea prompted a group of physicians there to make a high-profile public appeal in print and on television recommending against thyroid screening with ultrasound.
The result was a 35% reduction in the number of thyroidectomies performed in the subsequent year.
“This seems to be a striking example that the issue of overdiagnosis and overtreatment resonates with patients, and that public awareness can lead to changes in behavior,” say the U.S. authors of that article.
Senior author Louise Davies, MD, of the VA Outcomes Group, in White River Junction, Vt., said in an interview that the new study sheds more light on this issue.
“Even though the data only go through 2012, I think they give a nice snapshot of what’s happening across the globe with thyroid cancer incidence in countries of different levels of development,” she said.
The findings underscore that “it’s important that people are educated about the limits of medical testing and that sometimes when we see abnormalities we are truly catching a cancer early, but sometimes we’re seeing things that have been there a long time and may not change or become a problem in the future,” Dr. Davies remarked.
Important to know what size of cancers are being detected
One particular concern about overdiagnosis in middle-income countries is that the common approach of active monitoring may be more difficult in these settings, Dr. Davies added.
“In order to manage overdiagnosis, the health care systems in those countries have to think about whether they have the infrastructure for active monitoring and whether the patients will show up for the monitoring – so that’s a challenge.”
Also, she noted that the new study does not detail the size of cancers detected.
“We don’t know much about the size of the cancers being detected and whether these are truly the small asymptomatic cancers that we are worried about being overdiagnosed.”
“Probably, at least some of what we’re seeing is appropriate detection of cancers that, before there was economic development, were in fact being missed and people were dying of,” she said.
“So while overdiagnosis can be occurring, some of this represents better detection of disease overall, and that’s a good thing actually.”
The authors and Dr. Davies have reported no relevant financial relationships.
A version of this article originally appeared on Medscape.com.