All thyroid cancers are not 'created equal'– avoiding unnecessary or 'excessive' treatment

More Americans are being diagnosed with thyroid cancer than ever before–over the past 25 years its incidence has tripled. This year alone, more than 50,000 people in the U.S., the majority of them of women, will receive a thyroid cancer diagnosis. Yet, despite the dramatic rise in the rate of diagnosis, morality due to thyroid cancer has remained stable.

In an upcoming article in the New England Journal of Medicine, Drs. H. Gilbert Welch (The Dartmouth Institute for Health Policy and Clinical Practice) and Gerard Doherty (Dept. of Surgery, Brigham and Women’s Hospital), assert that this steep increase in the number of people being diagnosed with thyroid cancer–largely reflecting the detection of small papillary thyroid cancers–points to widespread overdiagnosis. Efforts to reduce overdiagnosis are needed, such as refraining from biopsying small thyroid nodules as advocated by the American Thyroid Association. But, Welch and Doherty also advocate strongly for measures designed to reduce overtreatment. These include:

Active surveillance for selected patients with small papillary thyroid cancers In cases where patients prefer to remove the cancer, Welch and Doherty state the case for a thyroid lobectomy (removal of about half the thyroid gland), the lesser of the two surgical options available,


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