Increase in Thyroid Cancer Mortality Following Overdiagnosis Controversy
"Both Overdiagnosis and Underdiagnosis Require Caution"
The mortality rate of thyroid cancer, which was known as the "turtle cancer" or "good cancer" due to its high survival rate and slow progression, has been found to have increased. In particular, it was confirmed that the mortality rate has risen since the overdiagnosis and overtreatment controversy about a decade ago.
On the 7th, a research team led by Professors Kim Shingon and Kim Kyungjin from the Department of Endocrinology at Korea University Anam Hospital published the results of an analysis on changes in thyroid cancer mortality rates after the overdiagnosis controversy in the internationally renowned journal International Journal of Surgery. The results showed that although the number of diagnosed cases decreased after the past controversy, the mortality rate has been increasing since then.
The research team analyzed mortality rate changes among a total of 434,228 thyroid cancer patients using data from the National Health Insurance Service from 2005 to 2018. The incidence rate of thyroid cancer in Koreans steadily increased from 2005 to 2012 but declined after the overdiagnosis controversy arose. The number of thyroid cancer patients in Korea, which was 91.9 per 100,000 people in 2012, sharply dropped to 50.6 in 2015 after the controversy. It then stabilized until 2018.
During the same period, the thyroid cancer mortality rate decreased from 1.94 per 1,000 people in 2005 to 0.76 in 2013. However, it increased again to 2.70 in 2018. In particular, the mortality rate of patients who did not undergo thyroidectomy or who had total thyroidectomy increased after 2013, while the mortality rate of patients who underwent hemithyroidectomy or partial thyroidectomy remained low throughout the period.
The research team stated, "The increase in thyroid cancer-related mortality after 2015 suggests that there are points to improve in the diagnostic and treatment criteria applied after the overdiagnosis controversy," and emphasized, "It is necessary to accurately assess the risk of thyroid cancer to provide appropriate diagnosis and active treatment for high-risk patients, while reducing overtreatment and ensuring precise follow-up for low-risk patients. Efforts from the academic community will be essential."
In other words, although thyroid cancer generally has a very good prognosis, there are rare cases with very poor prognosis. Because it exhibits both extremes, the research team concluded that caution is needed to avoid both overtreatment and undertreatment.
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