Ethical issues raised by thyroid cancer overdiagnosis

a matter for public health?

Wendy Rogers (Corresponding Author), Wendy Craig, Vikki A Entwistle

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Current practices of identifying and treating small indolent thyroid cancers constitute an important but in some ways unusual form of overdiagnosis. Overdiagnosis refers to diagnoses that generally harm rather than benefit patients, primarily because the diagnosed condition is not a harmful form of the disease in question. With thyroid cancer overdiagnosis, individual patients are harmed by the psycho-social impact of a cancer diagnosis, as well as treatment interventions that may include partial or total thyroidectomy, lifelong thyroid replacement hormone, monitoring, surgical complications and other side effects. These harms seem unlikely to be outweighed by any putative benefit of knowing about a cancer that would not have caused problems if not identified or treated. In addition to harms to patients, there are significant opportunity costs at a societal level of treating and supporting large numbers of patients overdiagnosed with thyroid cancer.
Unlike many other overdiagnosed cancers, accurate risk stratification is possible with thyroid cancer. Within clinical ethics frameworks, which emphasise beneficence and non-maleficence and respect for patients’ autonomy, the use of this risk information might support informed choice and/or shared decision-making at an individual patient level. And this approach might, to some extent, help to reduce rates of diagnosis and intervention. In practice, however, it is unlikely to stem the rising incidence and associated harms and costs of overdiagnosed thyroid cancer, especially in situations where health professionals’ interests are conflicted. We argue in this paper that thyroid cancer overdiagnosis should also be understood as a public health problem, and that some public health approaches will be readily justifiable and are more likely to be effective in minimising its harms.
Original languageEnglish
Pages (from-to)590-598
Number of pages9
JournalBioethics
Volume31
Issue number8
Early online date13 Sep 2017
DOIs
Publication statusPublished - Oct 2017

Fingerprint

Thyroid Neoplasms
Ethics
cancer
Public Health
public health
Clinical Ethics
Beneficence
Patient Harm
Costs and Cost Analysis
Neoplasms
Thyroidectomy
Medical Overuse
Cancer
Ethical Issues
Social Change
Thyroid Hormones
opportunity costs
Decision Making
social effects
health professionals

Keywords

  • conflicts of interest
  • ethics
  • overdiagnosis
  • public health
  • shared decision-making
  • thyroid cancer

Cite this

Ethical issues raised by thyroid cancer overdiagnosis : a matter for public health? . / Rogers, Wendy (Corresponding Author); Craig, Wendy ; Entwistle, Vikki A.

In: Bioethics, Vol. 31, No. 8, 10.2017, p. 590-598.

Research output: Contribution to journalArticle

Rogers, Wendy ; Craig, Wendy ; Entwistle, Vikki A. / Ethical issues raised by thyroid cancer overdiagnosis : a matter for public health? . In: Bioethics. 2017 ; Vol. 31, No. 8. pp. 590-598.
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abstract = "Current practices of identifying and treating small indolent thyroid cancers constitute an important but in some ways unusual form of overdiagnosis. Overdiagnosis refers to diagnoses that generally harm rather than benefit patients, primarily because the diagnosed condition is not a harmful form of the disease in question. With thyroid cancer overdiagnosis, individual patients are harmed by the psycho-social impact of a cancer diagnosis, as well as treatment interventions that may include partial or total thyroidectomy, lifelong thyroid replacement hormone, monitoring, surgical complications and other side effects. These harms seem unlikely to be outweighed by any putative benefit of knowing about a cancer that would not have caused problems if not identified or treated. In addition to harms to patients, there are significant opportunity costs at a societal level of treating and supporting large numbers of patients overdiagnosed with thyroid cancer. Unlike many other overdiagnosed cancers, accurate risk stratification is possible with thyroid cancer. Within clinical ethics frameworks, which emphasise beneficence and non-maleficence and respect for patients’ autonomy, the use of this risk information might support informed choice and/or shared decision-making at an individual patient level. And this approach might, to some extent, help to reduce rates of diagnosis and intervention. In practice, however, it is unlikely to stem the rising incidence and associated harms and costs of overdiagnosed thyroid cancer, especially in situations where health professionals’ interests are conflicted. We argue in this paper that thyroid cancer overdiagnosis should also be understood as a public health problem, and that some public health approaches will be readily justifiable and are more likely to be effective in minimising its harms.",
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