Cancer screenings, overdiagnosis and an “epidemic of treatment”

In November – or as it is now more commonly being referred to “Movember” – millions of men commit to grow moustaches to raise awareness of men’s health issues, such as prostate cancer, testicular cancer and mental health problems. One of the most important conversations which should be had this month – and every other month – is the one about appropriate screening tests – which ones to get, and which NOT to get, etc.

Let’s discuss thyroid cancer first. An op-ed published today in the New York Times by Dr. H. Gilbert Welch, professor of medicine at Dartmouth Institute for Health Policy and Clinical Practice, discusses the “epidemic of diagnoses” of thyroid cancer occurring in South Korea. There is no biological explanation for this “epidemic.” There is no new infectious agent. The explanation for this epidemic is that the government initiated a screening program meant to detect such cancers earlier and reduce its toll. Since screening for thyroid cancer is so easily done — requiring merely an ultrasound of the neck – many hospitals and doctors began to do this screening routinely. And surprise – more thyroid cancers! But what happened to the “toll” of thyroid cancer subsequently? Well, that toll was vanishingly small to begin with. The fact of the matter is that many of those thyroid cancers diagnosed were small “papillary thyroid cancers,” which would not have been discovered during a person’s life. This results in needless stress and an “epidemic of treatment,” subjecting patients to lifelong thyroid replacement therapy, all for an irregularity that would not have affected the person’s health in the first place.

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