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. 2014 Feb;3(1):154-61.
doi: 10.1002/cam4.184. Epub 2014 Jan 10.

Access, excess, and overdiagnosis: the case for thyroid cancer

Stephen F Hall  1 , Jonathan Irish, Patti Groome, Rebecca Griffiths
Affiliations

Access, excess, and overdiagnosis: the case for thyroid cancer

Stephen F Hall et al. Cancer Med. 2014 Feb.

Abstract

The incidence of thyroid cancer in women is increasing at an epidemic rate. Numerous studies have proposed that the cause is increasing detection due to availability and use of medical diagnostic ultrasound. Our objective was to compare rates of diagnosis across different health-care regions to rates of diagnostic tests and to features of both health and access of the regional populations. This is a population-based retrospective ecological observational study of 12,959 patients with thyroid cancer between January 1, 2000 and December 31, 2008 in Ontario Canada based on the health-care utilization regions (Local Health Integration Networks) of the province of Ontario Canada. We found that some regions of Ontario had four times the rates of diagnosis of thyroid cancer compared to other regions. The regions with the highest use of discretionary medical tests (pelvic ultrasound, abdominal ultrasound, neck ultrasound, echocardiogram, resting electrocardiogram, cardiac nuclear perfusion tests, and bone scan), highest population density, and better education had the highest rates of thyroid cancer diagnoses. Differences in the rates of the ordering of discretionary diagnostic medical tests, such as diagnostic ultrasound, in different geographic regions of Ontario lead to differences in the rates of diagnosis of thyroid cancer.

Keywords: Access; incidence; medical tests; overdiagnosis; thyroid cancer.

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Figures

Figure 1
Figure 1
New cases per 100,000 by year in Ontario.
Figure 2
Figure 2
Diagnosis rate (per 100,000) over 9 years by LHINs.
Figure 3
Figure 3
Scatter plot of the number of neck ultrasound examinations (per 100,000) versus diagnosis rate (per 100,000) over 9 years for each LHIN.
See this image and copyright information in PMC

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