| . Today's Managing Health Care Costs Number is 3X |
The US Preventive Services Task Force (USPSTF) released its finding on screening for thyroid cancer last week. It gave such screening a "D" grade, meaning "there is moderate to high certainty that the service has no net benefit or that the harms outweigh the benefits."
The USPSTF:
Although ultrasonography of the neck using high-risk sonographic characteristics plus follow-up cytology from fine-needle aspiration can identify thyroid cancers, it is unclear if population-based or targeted screening can decrease mortality rates or improve important patient health outcomes. Screening that results in the identification of indolent thyroid cancers, and treatment of these overdiagnosed cancers, may increase the risk of patient harms.
It's about time - as there is substantial evidence that screening for thyroid cancer finds a huge number of "incidental" lumps that are read by pathologists as cancer -but would not have had an impact on life expectancy or quality if left alone or not found in the first place. When these are found, though, the patient willhave a thyroidectomy, and 2-6% will have hypoparathyroidism (trouble with calcium regulation) and 1-2% will have nerve damage.
As you can see, even absent a recommendation to do thyroid cancer screening, we have seen more than a 3-fold increase in incidence of thyroid cancer from 1995-2013, with little change in mortality rate during this time. If these extra cases of thyroid cancer diagnosis were saving lives we'd expect to see a drop in mortality - while it has actually ticked up slightly.
Gilbert Welch of Dartmouth worries in an accompanying editorial that proposed legislation would dilute the integrity of the US Preventive Services Task Force by including self-interested representatives from the companies manufacturing screening tests and devices. He writes:
Currently, the Task Force is an independent volunteer panel of 16 members who are nationally recognized experts in prevention, evidence-based medicine, and primary care. The proposed legislation would expand its composition to include specialty care clinicians as well as “relevant stakeholders from the medical products manufacturing community.”Would it really be helpful to include manufacturers of neck ultrasonographic equipment and thyroid replacement drugs in the evaluation of thyroid cancer screening?
The USPSTF serves a vital function in promoting effective preventive care - and helping be sure we don't aggressively promote preventive care that might be value destroying (like population-wide prostate cancer screening, or too-frequent mammography started too young). It's hard to believe that a reconstituted USPSTF that had self-interested parties would help us be more evidence-based in our decision-making. It's easy to see how a suggested change like this would increase medical costs.
EmoticonEmoticon