Screening is often recommended as the first line of prevention for most cancers. However, recent recommendation from the US Preventive Services Task Force (USPSTF) advises against thyroid cancer screening in nonsymptomatic adults. The rationale behind this recommendation was reported in the Journal of the American Medical Association (JAMA).
The USPSTF is an independent, volunteer panel of experts in prevention and evidence-based medicine that together make recommendations about the effectiveness of preventive care services including screenings, counseling services, and preventive medications.
The recommendation is classified as a “D” recommendation, meaning there is a moderate to high possibility that screening has no overall benefit or that the harm outweighs any benefits.
According to the report, there was not enough evidence to determine the accuracy of screening methods, including neck palpation and ultrasound or that screening improved overall health outcomes. The panel determined that there is only a small benefit gained from screening based on the relative frequency of thyroid cancer, the difference in results between patients who are treated and patients who are monitored, and the lack of change in mortality rates in areas with screening programs. While the incidence of thyroid cancer has increased 4.5% in the last 10 years, the 5-year survival rate for patients with thyroid cancer is 98.1%.
The USPSTF also determined that the overall harm of screening could be classified as at least moderate, due to the harms of thyroid cancer treatment and the likelihood of overdiagnosis and overtreatment caused by screening.
The USPSTF also acknowledged that there are other factors to be considered beyond the realm of their report. They cautioned that “clinicians should understand the evidence but individualize decision making to the specific patient or situation. Similarly… policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms.”
1. US Preventive Services Task Force. Screening for thyroid cancer US Preventive Services Task Force recommendation statement. JAMA. 2017;317(18):1882-1887.