USPSTF Releases Guidance on Screening for Thyroid Cancer
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Restate the conclusion of the USPSTF task force on routine screening for thyroid cancer in asymptomatic individuals 2. Discuss the symptoms/factors which would prompt screening for thyroid cancer
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
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Screening for thyroid cancer includes the identification of nodules by neck palpation or ultrasound. Detection can also be incidental, for example at the time of carotid ultrasonography or chest CT. Nodules are mostly benign with only 7 to 9% considered cancerous on pathology and even then, malignant cells are usually well contained. Overall prognosis is excellent with less than 2% mortality at 5 years. Research indicates that even when thyroid carcinomas are detected early, mortality rates remain unchanged. Thus, patients may be exposed to surgeries and treatments that carry risk but may not result in benefit.
Based on the assessment of the current literature the task force concludes the following:
The USPSTF concludes with moderate certainty that screening for thyroid cancer in asymptomatic persons results in harms that outweigh the benefits.
The USPSTF recommends against screening for thyroid cancer in asymptomatic adults (D recommendation).
Of note, this applies to asymptomatic, low risk adults. This guidance does not apply to individuals with the following:
Hoarseness, pain, difficulty swallowing
Abnormal neck exam
Lumps, swelling, asymmetry of the neck and other similar findings
Increased risk of thyroid cancer
History of exposure to ionizing radiation (such as medical treatment or radiation fallout)
Inherited genetic syndromes associated with thyroid cancer (e.g., familial adenomatous polyposis)
First-degree relative with a history of thyroid cancer
Patients with the above require an individualized management plan based on their clinical findings.
The accompanying editorial makes the point that more research is still warranted as the thyroid cancer incidence-based mortality is rising at approximately 1.1% per year. In addition, imaging techniques continue to improve. Therefore, ultrasound screening may become more effective in the future by incorporating specific sonographic characteristics.
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presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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