Ethical issues raised by thyroid cancer overdiagnosis

a matter for public health?

Wendy A. Rogers*, Wendy L. Craig, Vikki A. Entwistle

*Corresponding author for this work

Research output: Contribution to journalArticle

10 Citations (Scopus)
3 Downloads (Pure)

Abstract

Current practices of identifying and treating small indolent thyroid cancers constitute an important but in some ways unusual form of overdiagnosis. Overdiagnosis refers to diagnoses that generally harm rather than benefit patients, primarily because the diagnosed condition is not a harmful form of disease. Patients who are overdiagnosed with thyroid cancer are harmed by the psycho-social impact of a cancer diagnosis, as well as treatment interventions such partial or total thyroidectomy, lifelong thyroid replacement hormone, monitoring, surgical complications and other side effects. These harms seem to outweigh any putative benefit of knowing about a cancer that would not have caused problems if left undiscovered. In addition to harms to patients, thyroid cancer overdiagnosis leads to significant opportunity costs at a societal level, due to costs of diagnosis and treatment. Unlike many other overdiagnosed cancers, accurate risk stratification is possible with thyroid cancer. At the individual patient level, use of this risk information might support informed choice and/or shared decision-making, as mandated by clinical ethics frameworks. And this approach might, to some extent, help to reduce rates of diagnosis and intervention. In practice, however, it is unlikely to stem the rising incidence and associated harms and costs of overdiagnosed thyroid cancer, especially in situations where health professionals have conflicts of interest. We argue in this article that thyroid cancer overdiagnosis may be usefully understood as a public health problem, and that some public health approaches will be readily justifiable and are more likely to be effective in minimising its harms.

Original languageEnglish
Pages (from-to)590-598
Number of pages9
JournalBioethics
Volume31
Issue number8
DOIs
Publication statusPublished - 1 Oct 2017

Bibliographical note

Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Keywords

  • conflicts of interest
  • ethics
  • overdiagnosis
  • public health
  • shared decision-making
  • thyroid cancer

Fingerprint Dive into the research topics of 'Ethical issues raised by thyroid cancer overdiagnosis: a matter for public health?'. Together they form a unique fingerprint.

Cite this