Stop biopsying small thyroid nodules and never screen the thyroid
South Korea's thyroid cancer rate rose 15-fold after ultrasound screening, with no fall in deaths. A firm rule not to biopsy nodules under 1 cm, and not to screen, would prevent this harm elsewhere.
Korean thyroid overdiagnosis is the clearest natural experiment in the field, and incidence fell after the 2014 public debate without any mortality change. Guidelines already discourage biopsy of sub-centimetre nodules but practice varies. Propose national policy: no ultrasound thyroid screening, mandatory adherence to size thresholds, and public reporting of the thyroid cancer incidence-to-mortality ratio as a harm indicator.
- Overdiagnosis and false alarms · Finding more cancer is not the same as saving lives. Screening also finds cancers that would never have hurt anyone, and treats them.
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