Intended for healthcare professionals


Screening without evidence of efficacy

BMJ 2004; 328 doi: (Published 26 February 2004) Cite this as: BMJ 2004;328:521

Thyroid ultrasonography is another example

  1. Yair Liel, head, endocrine service (liel{at}
  1. Soroka University Medical Centre, Beer-Sheva, Israel

    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


    • Competing interests None declared.


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