美国国家公共电台 NPR Don't Screen For Thyroid Cancer, Task Force Says

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ROBERT SIEGEL, HOST:

Screening healthy people to look for thyroid cancer does more harm than good. That's the word from doctors on a federal health advisory¹ committee. NPR's Richard Harris has the story.

RICHARD HARRIS, BYLINE²: More and more people are being diagnosed with thyroid cancer in the United States, but the death rate remains³ very low, and it isn't going up. The simple explanation - more and more harmless cancers are being detected.

SETH LANDEFELD: I think the common conception is that every cancer is going to grow until it's stopped or removed or kills you. That is not the case with these cancers.

HARRIS: Dr. Seth Landefeld is on the U.S. Preventive Services Task Force which has come out strongly against screening for these cancers in the current issue of JAMA. The treatment isn't benign⁴. It usually involves surgical⁵ removal of the thyroid gland⁶ and a lifetime of drugs to replace the hormone⁷ the gland produces.

LANDEFELD: And in a couple of percent of patients, it leads to injury to the laryngeal nerves that can lead to voice and swallowing difficulties.

HARRIS: And all these surgeries don't lead to longer or healthier lives. Dr. H. Gilbert Welch at the Dartmouth Institute for Health Policy and Clinical Practice says the task force made a good call.

H GILBERT WELCH: The evidence in thyroid cancer is if you look early, you just find a whole new category of patients that has the disease but is never going to suffer from it at all, but they will suffer from the treatment.

HARRIS: He says South Korea is the poster child for overdiagnosis. Some years ago, doctors there started a mass screening campaign to look for thyroid cancer.

WELCH: And 15 years later, thyroid cancer became the most common cancer in Korea, more common than breast, more common than colon⁸, more common than lung.

HARRIS: Tens of thousands of Koreans were getting surgery.

WELCH: But nothing changed in the death rate. The death rate was totally flat.

HARRIS: Landefeld, who's at the University of Alabama at Birmingham, says his task force's call to avoid testing for thyroid cancer only applies to people without any symptoms.

LANDEFELD: As soon as somebody has symptoms, you know, such as a swelling⁹ in the neck or change in their voice or change in their swallowing or pain in the neck, you're in a different ballpark. You'll really want to sort those symptoms out.

HARRIS: Thyroid cancer caught at that point is still curable most of the time. Richard Harris, NPR News.