Association between screening and the thyroid cancer "epidemic" in South Korea: evidence from a nationwide study

OBJECTIVE To investigate whether screening for thyroid cancer led to the current "epidemic"in South Korea. DESIGN Review of the medical records of nationally representative samples of patients with a diagnosis of thyroid cancer in 1999, 2005, and 2008. SETTING Sample cases were randomly selected from South Korea's nationwide cancer registry, using a systematic sampling method after stratification by region. PARTICIPANTS 5796 patients with thyroid cancer were included (891 in 1999, 2355 in 2005, and 2550 in 2008). MAIN OUTCOME MEASURES The primary outcome was age standardised incidence of thyroid cancer and the changes in incidence between 1999 and 2008 according to the methods used to detect tumours (screen detection versus clinical detection versus unspecified). RESULTS Between 1999 and 2008, the incidence of thyroid cancer increased 6.4-fold (95% confidence interval 4.9-fold to 8.4-fold), from 6.4 (95% confidence interval 6.2 to 6.6) per 100 000 population to 40.7 (40.2 to 41.2) per 100 000 population. Of the increase, 94.4% (34.4 per 100 000 population) were for tumours less than 20 mm, which were detected mainly by screening. 97.1% of the total increase was localised and regional tumours according to the Surveillance, Epidemiology, and End Results (SEER) summary stage. Where cases were clinically detected, 99.9% of the increased incidences (6.4 per 100 000 population) over the same period were tumours less than 20 mm. CONCLUSION The current "epidemic"of thyroid cancer in South Korea is due to an increase in the detection of small tumours, most likely as a result of overdetection. Concerted efforts are needed at a national level to reduce unnecessary thyroid ultrasound examinations in the asymptomatic general population.