Kirsten Bibbins-Domingo, MD, PhD
AS REPORTED in JAMA, the U.S. Preventive Services Task Force (USPSTF) has recommended against thyroid cancer screening in asymptomatic individuals.1 The current USPSTF statement is an update of a 1996 USPSTF recommendation statement. The recommendation was based on Task Force review of evidence on the benefits and harms of screening, diagnostic accuracy of screening (including neck palpation and ultrasound), and the benefits and harms of treatment of screen-detected disease.
Kirsten Bibbins-Domingo, MD, PhD, of the University of California, San Francisco, is the corresponding author of the JAMA article.
Task Force Findings
THE USPSTF STATED: “[The Task Force] found inadequate direct evidence on the benefits of screening but determined the magnitude of the overall benefits of screening and treatment can be bounded as no greater than small, given the relative rarity of thyroid cancer, the apparent lack of difference in outcomes between patients who are treated vs monitored (for the most common tumor types), and observational evidence showing no change in mortality over time after introduction of a mass screening program.”
They further stated: [“The Task Force] found inadequate direct evidence on the harms of screening but determined the overall magnitude of the harms of screening and treatment can be bounded as at least moderate, given adequate evidence of the harms of treatment and indirect evidence that overdiagnosis and overtreatment are likely to be substantial with population-based screening…. The [Task Force] therefore determined the net benefit of screening for thyroid cancer is negative.”
The summary of the USPSTF statement is reproduced here.
Recommendation Summary
- Population: Asymptomatic adults
- Recommendation: Do not screen for thyroid cancer. Grade D [Grade D = USPSTF recommends against the service. There is moderate or high certainty the service has no net benefit or the harms outweigh the benefits. Suggestions for practice: Discourage the use of this service.]
- Risk Assessment: Factors that substantially increase the risk for thyroid cancer include a history of radiation exposure to the head and neck as a child; exposure to radioactive fallout; a family history of thyroid cancer in a first-degree relative; and certain genetic conditions, such as familial medullary thyroid cancer or multiple endocrine neoplasia syndrome (type 2A or 2B).
- Screening Tests: Evidence is inadequate to estimate the accuracy of neck palpation or ultrasound of the thyroid as screening tests for thyroid cancer in asymptomatic persons.
- Treatment: Surgery (ie, total or partial thyroidectomy, with or without lymphadenectomy) is the main treatment of thyroid cancer. Additional treatment, including radioactive iodine therapy, may be indicated, depending on the postoperative disease status, tumor stage, and type of thyroid cancer. External-beam radiation therapy and chemotherapy are not generally used to treat early-stage, differentiated thyroid cancer.
- Balance of Benefits and Harms: The USPSTF concludes with moderate certainty that screening for thyroid cancer in asymptomatic persons results in harms that outweigh the benefits.
The task force concluded: “The USPSTF recommends against screening for thyroid cancer in asymptomatic adults (grade D recommendation).” ■
DISCLOSURE: For full disclosures of the authors, visit www. jama.jamanetwork.com.
REFERENCE
1. U.S. Preventive Services Task Force, Bibbins-Domingo K, Grossman DC, et al: Screening for thyroid cancer. U.S. Preventive Services Task Force recommendation statement. JAMA 317:1882-1887, 2017.
