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Access, excess, and overdiagnosis: the case for thyroid cancer
Stephen F Hall1, Jonathan Irish, Patti Groome
1Cancer Care and Epidemiology, Queen's Cancer Research Institute, Queen's University, Kingston, Ontario, Canada.
Cancer Medicine
|January 11, 2014
Summary
Rising thyroid cancer diagnoses in women are linked to increased medical screening. Regions with higher diagnostic test use, including ultrasound, show significantly higher thyroid cancer detection rates.
Area of Science:
- Endocrinology
- Oncology
- Public Health
Background:
- Thyroid cancer incidence, particularly in women, is rising rapidly.
- Increased medical diagnostic ultrasound use is a suspected driver of this trend.
- Geographic variations in healthcare access and diagnostic practices may influence cancer detection rates.
Purpose of the Study:
- To investigate the correlation between regional diagnostic test utilization and thyroid cancer diagnosis rates in Ontario, Canada.
- To identify factors associated with disparities in thyroid cancer detection across different healthcare regions.
Main Methods:
- Population-based retrospective ecological observational study.
- Analysis of 12,959 thyroid cancer cases diagnosed between 2000 and 2008 in Ontario.
- Comparison of cancer diagnosis rates with regional healthcare utilization, diagnostic test frequency, population density, and education levels.
Main Results:
- Significant regional variations in thyroid cancer diagnosis rates were observed, with some areas having four times higher rates than others.
- Regions with higher rates of discretionary diagnostic tests (e.g., ultrasounds, echocardiograms, bone scans) exhibited higher thyroid cancer diagnosis rates.
- Higher population density and better educational attainment were also associated with increased diagnosis rates.
Conclusions:
- Disparities in the ordering of discretionary diagnostic medical tests, particularly ultrasound, contribute to regional differences in thyroid cancer diagnosis rates.
- Increased access to and utilization of diagnostic technologies appear to be key factors in the rising incidence of thyroid cancer.
- Healthcare policy and resource allocation may need to address variations in diagnostic test ordering to mitigate potential overdiagnosis.
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