The incidence of cancer in nodular goiters removed at Sacred Heart Hospital, Spokane, was 7%. In 60% the cancer was considered benign clinically and even at the time of surgery. Nodules of any type in patients under 30 years of age have proved malignant in 37% of cases. Of the nontoxic multinodular goiters, 5.7% were malignant in this series. The incidence of cancer appeared to be much higher in those with a history of recent growth or pressure symptoms or with firm discrete nodules. These signs and symptoms seem to be definite indications for surgical investigation. It is felt that all nodules in young people should be treated surgically.