Overdiagnosis of thyroid cancer in the United States: Improved estimates based on the SEER registries during 2000-2019.

Abstract

The rising thyroid cancer (TC) incidence is largely attributed to overdiagnosis, primarily due to widespread use of sensitive imaging technologies. Prior estimates of overdiagnosis relied on generalized assumptions that may not account for population-specific risk exposures and diagnostic trends. This study aims to provide more accurate estimates by addressing previous methodological limitations. In this population-based study, we obtained aggregated data on the incidence and mortality of TC during 2000 to 2019 from the Surveillance, Epidemiology, and End Results 22 (SEER-22) and SEER-17. The age-standardized incidence (ASIR) and mortality rates (ASMR) were calculated by sex, histology, stage, and 5-year periods. Overdiagnosis rates were estimated using population-specific parameters derived from the multistage model of carcinogenesis. The ASIR of papillary thyroid cancer (PTC) and non-PTC increased rapidly in both men and women during 2000 to 2014 and stabilized thereafter, whereas the ASMR remained relatively unchanged. The overdiagnosis was mainly observed for differentiated TC subtypes, including PTC and follicular TC. A total of 50,239 (63.5%) men and 203,429 (79.5%) women cases of PTC were attributable to overdiagnosis, accounting for 73.9% of early-stage PTC in men and 85.2% in women. In contrast, no significant overdiagnosis was observed for non-PTC overall, with an 11.0% underdiagnosis rate in men and a 19.2% overdiagnosis rate in women. This study presents refined estimates of TC overdiagnosis and highlights the continued impact of early detection on incidence trends. The findings support the need for risk stratification for TC screening and management to minimize the potential overtreatment while ensuring the timely detection of clinically significant cases.