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The last four decades have witnessed an explosion of thyroid cancer diagnoses in the U.S. People are three times more likely to receive cancer diagnoses now than they were in 1975.
Why? Is it chemicals in the water supply? A side effect of all those childhood vaccines? Or is it because a TV ad convinced people to ask their doctors to check their neck?
I have examined thousands of patients’ necks in my career. I ask them to drink water while I feel the contours of their thyroid for suspicious asymmetries. If I feel anything suspicious, like a lump, I follow up with blood tests and ultrasound exams, to see if my patient is harboring a potentially dangerous growth. Here’s the problem with all that neck checking—there’s no evidence it saves lives. But there is solid evidence that it leads to diagnoses of non-threatening thyroid cancers. Here’s a picture showing the dramatic increase in cancer diagnoses over the last four decades (the two rising lines) and the unchanged percent of Americans dying of thyroid cancer (the completely flat line at the bottom):
Thyroid growths are generally removed surgically, or with radiation; they aren’t eradicated with medications. So why would drug companies care about thyroid cancer diagnoses? Because once people have thyroid surgery, they usually need to take thyroid replacement pills. Or if they get thyroid radiation, they take medications like Thyrogen, manufactured by Sanofi Genzyme, one of the corporate sponsors of the thyroid screening public service announcements.
Recently, Gil Welch from Dartmouth warned that independent medical organizations, like the United States Preventive Services Task Force, are under threat because their screening recommendations go against corporate interests. The Task Force is a highly-respected panel of experts who evaluate evidence about preventive care—16 brainiacs who for little or no money try to help the American healthcare system figure out which preventive services promote health and well-being. The Task Force, it should be noted, gave thyroid screening a grade of D. If healthcare professionals follow the Task Force’s guidance, we will all benefit from less unnecessary testing and treatment. But a small, concentrated group of companies with strong economic interests will lose out. Concentrated power often wins out over diffuse public interests.
The U.S. federal government needs to make sure important groups like the Task Force are protected from special interest groups. And the American people should hesitate before letting doctors check their necks, when they don’t have any signs or symptoms to warrant such examinations.
