To the Editor: In their study of the increasing incidence of thyroid cancer in the United States between 1973 and 2002, Drs Davies and Welch1 concluded that the increase was artifactual, due to increasing detection of small thyroid nodules. We believe that this conclusion is premature. Use of imaging technology for the thyroid may have begun increasing in the early 1980s, but workup for thyroid disease generally occurs because of symptoms or signs. We are not aware of any organized, concerted, sustained effort in thyroid cancer screening.
Davies and Welch observed the greatest increase in incidence for cancers less than 1 cm in diameter, but they show that tumors of 1 to 2 cm and 2 to 5 cm in diameter have also been strongly increasing in incidence. Nodules about 1 cm in diameter are detectable by palpation, and those 2 to 5 cm in diameter are frequently visually apparent and unlikely to be undetected or to be observed clinically but not worked up for cancer. If incidence of thyroid cancer were indeed increasing, with modern diagnostic technology most tumors would be detected near the smallest sizes detectable with palpation. Thus, the increase in incidence of small- to medium-sized cancers is just as consistent with a true increase in disease incidence as with increasing detection of existing subclinical tumors. We believe that the reasoning concerning thyroid mortality used by Davies and Welch involves weak evidence.
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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