BMJ  2004;328:521 (28 February), doi:10.1136/bmj.328.7438.521

Letter

Screening without evidence of efficacy

Thyroid ultrasonography is another example

The first 100% of the full text of this article appears below.

EDITOR—I agree with Law's view of screening, that screening of unproved value should not be advocated.¹ As a clinical endocrinologist I often have to deal with patients' anxieties about non-palpable incidental findings on thyroid ultrasonography, often performed for wrong or unjustified reasons. Sometimes patients arrive with already established surgical complications after unnecessary thyroid operations.

Although a substantial number of incidental thyroid nodules may be histologically malignant,² their clinical importance has never been proved. A recent preliminary study indicates that the progression rate of non-palpable proved thyroid malignant nodules to clinically significant lesions may be very low.³ Thyroid ultrasonography is an additional example of an often used, often non-efficacious screening modality that may lead to "cascade iatrogenesis."⁴

Soroka University Medical Centre, Beer-Sheva, Israel liel@bgumail.bgu.ac.il

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Competing interests: None declared.

1. Law M. Screening without evidence of efficacy. BMJ 2004;328: 301-2. (7 February.)[Free Full Text]
2. Hagag P, Strauss S, Weiss M. Role of ultrasound guided fine needle aspiration biopsy in evaluation of nonpalpable thyroid nodules. Thyroid 1998;8: 989-95.[Web of Science][Medline]
3. Ito Y, Uruno T, Nakano K, Takamura Y, Miya A, Kobayashi K, et al. An observation trial without surgical treatment in patients with papillary microcarcinoma of the thyroid. Thyroid 2003;13: 381-7.[CrossRef][Web of Science][Medline]
4. Hofer TP, Hayward RA. Are bad outcomes from questionable clinical decisions preventable medical errors? A case of cascade iatrogenesis. Ann Intern Med 2002;137: 327-33.[Abstract/Free Full Text]

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Screening without evidence of efficacy

Malcolm Law
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• Steele, S. R., Martin, M. J., Mullenix, P. S., Azarow, K. S., Andersen, C. A. (2005). The Significance of Incidental Thyroid Abnormalities Identified During Carotid Duplex Ultrasonography. Arch Surg 140: 981-985 [Abstract] [Full text]  

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