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. 2016 Nov 30:355:i5745.
doi: 10.1136/bmj.i5745.

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

Sohee Park  1   2 , Chang-Mo Oh  1 , Hyunsoon Cho  1   3 , Joo Young Lee  4   5 , Kyu-Won Jung  1 , Jae Kwan Jun  1   3 , Young-Joo Won  1   3 , Hyun-Joo Kong  1 , Kui Son Choi  1   3 , You Jin Lee  6 , Jin Soo Lee  7   8
Affiliations

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

Sohee Park et al. BMJ. .

Abstract

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.

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Conflict of interest statement

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Trends in incidence of and mortality from thyroid cancer in South Korea, 1999-2012. The age standardised rates use Segi’s world standard population
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Fig 2 Differences in age standardised incidence of thyroid cancer per 100 000 population during 1999-2008 and 2005-08 by tumour size (top panel) and by Surveillance, Epidemiology, and End Results (SEER) summary stage (bottom panel). Error bars represent 95% confidence intervals of differences in age standardised incidence
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Fig 3 Absolute change over time in incidence of regional stage thyroid cancer by lymph node involvement and degree of extrathyroidal extension according to detection methods. Error bars represent 95% confidence intervals of differences in age standardised incidence during study period
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