Access, excess, and overdiagnosis: the case for thyroid cancer
Open Access
- 10 January 2014
- journal article
- research article
- Published by Wiley in Cancer Medicine
- Vol. 3 (1), 154-161
- https://doi.org/10.1002/cam4.184
Abstract
The incidence of thyroid cancer in women is increasing at an epidemic rate. Numerous studies have proposed that the cause is increasing detection due to availability and use of medical diagnostic ultrasound. Our objective was to compare rates of diagnosis across different health-care regions to rates of diagnostic tests and to features of both health and access of the regional populations. This is a population-based retrospective ecological observational study of 12,959 patients with thyroid cancer between January 1, 2000 and December 31, 2008 in Ontario Canada based on the health-care utilization regions (Local Health Integration Networks) of the province of Ontario Canada. We found that some regions of Ontario had four times the rates of diagnosis of thyroid cancer compared to other regions. The regions with the highest use of discretionary medical tests (pelvic ultrasound, abdominal ultrasound, neck ultrasound, echocardiogram, resting electrocardiogram, cardiac nuclear perfusion tests, and bone scan), highest population density, and better education had the highest rates of thyroid cancer diagnoses. Differences in the rates of the ordering of discretionary diagnostic medical tests, such as diagnostic ultrasound, in different geographic regions of Ontario lead to differences in the rates of diagnosis of thyroid cancer.Keywords
Funding Information
- Canadian Institutes of Health Research (84356)
- University of Toronto
This publication has 28 references indexed in Scilit:
- BMI, Diet and Female Reproductive Factors as Risks for Thyroid Cancer: A Systematic ReviewPLOS ONE, 2012
- Lead Times and Overdetection Due to Prostate-Specific Antigen Screening: Estimates From the European Randomized Study of Screening for Prostate CancerJNCI Journal of the National Cancer Institute, 2003
- An Observation Trial Without Surgical Treatment in Patients with Papillary Microcarcinoma of the ThyroidThyroid®, 2003
- Increasing thyroid cancer incidence in Canada, 1970–1996: time trends and age-period-cohort effectsBritish Journal of Cancer, 2001
- Occult papillary carcinoma of the thyroid. A study of 408 autopsy casesCancer, 1990
- Occult Carcinomas of the Thyroid: Evaluation of 1,020 Sequential AutopsiesAmerican Journal of Clinical Pathology, 1988
- THE ECOLOGICAL FALLACYAmerican Journal of Epidemiology, 1988
- Occult papillary carcinoma of the thyroid. A “normal” finding in finland. A systematic autopsy studyCancer, 1985
- Malignant thyroid tumors at autopsy in a Swedish goitrous populationCancer, 1985
- Occult thyroid carcinoma at autopsy in Malmö, SwedenCancer, 1981