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Value of mass screening for thyroid cancer
1Second Department of Surgery, School of Medicine, University of Tokushima, Japan.
World Journal of Surgery
|February 18, 1998
Summary
Mass screening for thyroid cancer detected early-stage tumors but did not improve patient prognosis. The study suggests independent thyroid cancer screening is not yet justified, despite cost-effectiveness when combined with other cancer screenings.
Area of Science:
- Oncology
- Public Health
- Diagnostic Medicine
Background:
- Mass screening for thyroid cancer, conducted alongside breast cancer screening since 1983 in Zentsuji, Japan, has an uncertain value.
- Previous evaluations have not definitively established the benefits of widespread thyroid cancer detection programs.
Purpose of the Study:
- To evaluate the effectiveness and clinical impact of mass screening for thyroid cancer.
- To determine if mass screening leads to earlier detection and improved outcomes compared to standard clinical presentation.
Main Methods:
- A cohort of 18,619 subjects underwent physical examination as part of mass screening for thyroid and breast cancer.
- Thyroid cancer cases detected were compared to those diagnosed in an outpatient clinic regarding tumor size and nodal metastasis.
- Cost-effectiveness was assessed by considering the additional time and resources required per subject.
Main Results:
- Thyroid cancer was detected in 0.19% of subjects (36 individuals), with detection rates of 0.40% initially and 0.10% subsequently.
- Screen-detected cancers were significantly smaller (14 mm vs. 19 mm) and had lower rates of nodal metastasis (38% vs. 68%) compared to outpatient cases.
- While cost-effective when integrated with other screenings (adding <1 minute per subject), no improvement in mortality or prognosis was observed.
Conclusions:
- Mass screening for thyroid cancer identifies tumors at an earlier stage.
- Despite early detection and cost-effectiveness when combined with other screenings, current evidence does not support independent mass screening for thyroid cancer due to a lack of demonstrated mortality reduction.