A qualitative study of women’s views on overdiagnosis and screening for thyroid cancer in Korea

Abstract

BackgroundThe incidence of thyroid cancer in Korea has increased by about 25 % every year for the past 10 years. This increase is largely due to a rising incidence in papillary thyroid cancer, which is associated with an overdiagnosis of small tumors that may never become clinically significant. This study was conducted to explore Korean women’s understanding of overdiagnosis and to investigate changes in screening intention in response to overdiagnosis information.MethodsFocus group interviews were conducted among women of ages 30–69 years, who are commonly targeted in Korea for cancer screening. Women were divided into four groups according to thyroid cancer screening history and history of thyroid disease. Of 51 women who were contacted, 29 (57 %) participated in the interviews.ResultsPrior awareness of thyroid cancer overdiagnosis was minimal. When informed about the risks of overdiagnosis, the participants were often surprised. Overcoming initial malcontent, many women remained skeptic about overdiagnosis and trusted in the advice of their physicians. Meanwhile, some of the study participants found explanations of overdiagnosis difficult to understand. Further, hearing about the risks of overdiagnosis had limited impact on the participants’ attitudes and intentions to undergo thyroid cancer screening, as many women expressed willingness to undergoing continued screening in the future.ConclusionA large majority of Korean women eligible for and had undergone thyroid cancer screening were unaware of the potential for overdiagnosis. Nevertheless, overdiagnosis information generally had little impact on their beliefs about thyroid cancer screening and their intentions to undergo future screening. Further research is needed to determine whether these findings could be generalized to the wider Korean population.

Growing incidence of thyroid carcinoma in recent years: Factors underlying overdiagnosis

“…Similarly, Park et al revealed that most patients are generally in favor of public screening strategies and that most consider the identification of small‐volume thyroid cancer as potentially lifesaving, which supports widespread use of diagnostic tests to explain the symptoms. Busco et al has proposed that some public concerns regarding the safety and health effects of environmental risk factors, such as nuclear energy, can prompt a spontaneous active surveillance.…”

“…In South Korea, primary care physicians frequently own an ultrasound machine 89 and order an ultrasound as an opportunistic screening test during a routine examination. 64 Nagar et al 90 explored the relationship between the age of the physician and incidence of well-differentiated thyroid cancer and found that geographic areas with a high proportion of physicians older than 55 years had a lower increase in incidence compared with areas with a high proportion of physicians younger than 55 years; the correlation was explained by the varying rate of technological adoption. Rosen et al 91 found a correlation between the female sex of the physician and a higher number of imaging studies, suggesting that the style of female physicians is more prone to active searching.…”

“…Udelsman and Zhang found a correlation between the US states with a higher increase in well‐differentiated thyroid cancer incidence and the proportion of endocrinologists and surgeons and number of ultrasound tests in these states. In South Korea, primary care physicians frequently own an ultrasound machine and order an ultrasound as an opportunistic screening test during a routine examination . Nagar et al explored the relationship between the age of the physician and incidence of well‐differentiated thyroid cancer and found that geographic areas with a high proportion of physicians older than 55 years had a lower increase in incidence compared with areas with a high proportion of physicians younger than 55 years; the correlation was explained by the varying rate of technological adoption.…”

Overdiagnosis in primary care: framing the problem and finding solutions

“…Currently, few patients who undergo cancer screening report discussing overdiagnosis with their physician, and it is likely that even fewer discuss overdiagnosis when they undergo screening for non-cancer conditions such as diabetes 109110. There are challenges to discussing overdiagnosis with patients; the concept may be difficult to understand and some may not recognize overdiagnosis as a real problem 111112. Patients who do appreciate the potential for overdiagnosis may be reluctant to raise concerns with their doctors.…”

The Impact of Thyroid Nodule Size and Fine-Needle Aspiration Biopsy Result on the Risk of Malignancy in the Patients Who Underwent Thyroidectomy

“…6,7) 한국에서는 국민건강보험공단의 암 검진(National Cancer Screening Program in Korea) 대상에 갑상선 암이 포함되어 있지 않으나, 많은 병원들에서 갑상선 암 검진을 위한 초음 파를 다른 국가에 비해 낮은 가격에 제공하고 있다. 11…”