USPSTF: No Thyroid Routine Cancer Screening for Asymptomatic Patients

The U.S. Preventive Services Task Force (USPSTF) does not recommend routine thyroid cancer screening among adults who are asymptomatic, according to a statement published in the Journal of the American Medical Association.  The USPSTF reviewed the evidence on the benefits and harms of screening for thyroid cancer in asymptomatic adults, the diagnostic accuracy of screening (including neck palpation and ultrasound), and the benefits and harms of treatment of screen-detected thyroid cancer. The rate of increase in thyroid cancer has been decreasing and is now at 2.1 percent per year, but the incidence of thyroid cancer detection has increased by 45 percent per year over the past decade. Mortality rate has increased, but only by 0.7 deaths per 100,000 person years. In addition, the five-year survival rate is high, at 98.1 percent overall, varying between 99.9 percent for localized disease to 55.3 percent for distant disease. The results of the review showed there was inadequate direct evidence on the benefits of screening. The task force did determine, however, that 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.  There was no inadequate direct evidence on the harms of screening but the task force determined the overall magnitude of the harms of screening and treatment can be bounded as at least moderate, given adequate evidence of harms of treatment and indirect evidence that over-diagnosis and over-treatment are likely to be substantial with population-based screening. The USPSTF, therefore, determined the net benefit of screening for thyroid cancer is negative. Given the findings, the USPSTF now recommends against screening for thyroid cancer in asymptomatic adults.