Disparities in Active Surveillance of Papillary Thyroid Microcarcinomas

Papillary thyroid microcarcinomas (PTMC) are small, typically indolent tumors that may be managed with surgery or active surveillance. However, active surveillance (AS) is resource intensive. We hypothesized that socioeconomic factors would affect likelihood of management with AS.

The National Cancer Database (NCDB) was queried to identify all patients with PTMCs larger than 3 mm treated between 2004 and 2024. Patients were divided into two groups: upfront surgery and AS. Demographics and facility level variables were compared between groups. Multivariable logistic regressions were applied to identify independent predictors of treatment with AS.

There were 64,463 patients treated for PTMC in the study period; 399 (0.6%) were managed with AS. The AS group had a higher proportion of Asian patients (16.0% vs. 7.1%) and a lower proportion of Black patients (2.0% vs. 6.4%) (P < 0.001). The majority (89.2%) of AS patients were treated at academic centers, compared with fewer than half (41.0%, P < 0.001) of surgery patients. Multivariable analysis showed Black race (adjusted odds ratio (aOR) 0.40, 95% CI 0.23-0.68, P < 0.01) and lower neighborhood socioeconomic status were associated with decreased likelihood of treatment with AS. Traveling farther for care (aOR 1.09 per 100 miles, (95% CI 1.07-1.12, P < 0.001)) was associated with increased odds of treatment with AS.

Black and Hispanic patients as well as patients from neighborhoods with lower median income are less likely to be treated with AS for PTMC. In contrast, patients traveling farther for care and being treated at academic centers were more likely to undergo AS, suggesting that socioeconomically advantaged patients may be traveling to high volume academic centers and choosing AS.