Endpoints for screening thyroid cancer in the Republic of Korea: thyroid specialists’ perspectives

J. H. An, Hoon Yub Kim, Sin Gon Kim, H. Dralle, G. W. Randolph, E. Piantanida, M. L. Tanda, G. Dionigi

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Cancer screening is aimed primarily at reducing deaths from the specific cancer. Thyroid-specific cancer mortality may be the most ambitious endpoint for obtaining estimates of screening effect. Numerous observations have accumulated over the years, indicating that thyroid cancer mortality endpoint has been difficult to study and is confounded by population heterogeneity, provision of randomization, and requirement of large cohorts with sufficiently long follow-up due to the excellent prognosis of the cancer. Accordingly, it may be important to reconsider how to best measure thyroid cancer screening efficacy. Recommendations against thyroid cancer screening should be based upon trials designed to evaluate its effectiveness not only in significant reduction in cancer mortality, but also of other distinct endpoints. It is desirable to evaluate derivative endpoints that can reliably predict reductions in mortality. The term “derivative” means a variable that is related to the true endpoint and is likely to be observable before the primary endpoint. Derivative endpoints may include thyroid cancer incidence, the proportion of early-stage tumors detected, more treatable stage, the identification of small tumors (to maintain in observation), decrease in the number of people who develop metastatic disease, the increased chance of lesser extent surgery, and the application of minimally invasive approaches, as well as no need for lifelong thyroid replacement therapy, a consistent follow-up, low-dose or no RAI administration and risk factor assessments where case findings should be continuous. The Korean guidelines for thyroid cancer national-level screening were published by a relevant group of multidisciplinary thyroid experts. It was concluded that the evidence is insufficient to balance the benefits and harms of thyroid cancer screening. However, the paper seems to raise the necessary investments in future research and demand a complete analysis for derivative endpoints, and offer screening participants with complete information necessary to make decisions that will provide them with the most value when a small thyroid cancer is screen-identified.

Original languageEnglish
Pages (from-to)683-685
Number of pages3
JournalJournal of Endocrinological Investigation
Volume40
Issue number6
DOIs
Publication statusPublished - 2017 Jun 1

Fingerprint

Republic of Korea
Thyroid Neoplasms
Thyroid Gland
Early Detection of Cancer
Mortality
Neoplasms
Minimally Invasive Surgical Procedures
Population Characteristics
Random Allocation
Observation
Guidelines
Incidence

Keywords

  • Epidemiology
  • RAI
  • Screening
  • Surgery
  • Thyroid cancer

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Endpoints for screening thyroid cancer in the Republic of Korea : thyroid specialists’ perspectives. / An, J. H.; Kim, Hoon Yub; Kim, Sin Gon; Dralle, H.; Randolph, G. W.; Piantanida, E.; Tanda, M. L.; Dionigi, G.

In: Journal of Endocrinological Investigation, Vol. 40, No. 6, 01.06.2017, p. 683-685.

Research output: Contribution to journalArticle

An, J. H. ; Kim, Hoon Yub ; Kim, Sin Gon ; Dralle, H. ; Randolph, G. W. ; Piantanida, E. ; Tanda, M. L. ; Dionigi, G. / Endpoints for screening thyroid cancer in the Republic of Korea : thyroid specialists’ perspectives. In: Journal of Endocrinological Investigation. 2017 ; Vol. 40, No. 6. pp. 683-685.
@article{67df8b8c713b4b4495800dd014c7914d,
title = "Endpoints for screening thyroid cancer in the Republic of Korea: thyroid specialists’ perspectives",
abstract = "Cancer screening is aimed primarily at reducing deaths from the specific cancer. Thyroid-specific cancer mortality may be the most ambitious endpoint for obtaining estimates of screening effect. Numerous observations have accumulated over the years, indicating that thyroid cancer mortality endpoint has been difficult to study and is confounded by population heterogeneity, provision of randomization, and requirement of large cohorts with sufficiently long follow-up due to the excellent prognosis of the cancer. Accordingly, it may be important to reconsider how to best measure thyroid cancer screening efficacy. Recommendations against thyroid cancer screening should be based upon trials designed to evaluate its effectiveness not only in significant reduction in cancer mortality, but also of other distinct endpoints. It is desirable to evaluate derivative endpoints that can reliably predict reductions in mortality. The term “derivative” means a variable that is related to the true endpoint and is likely to be observable before the primary endpoint. Derivative endpoints may include thyroid cancer incidence, the proportion of early-stage tumors detected, more treatable stage, the identification of small tumors (to maintain in observation), decrease in the number of people who develop metastatic disease, the increased chance of lesser extent surgery, and the application of minimally invasive approaches, as well as no need for lifelong thyroid replacement therapy, a consistent follow-up, low-dose or no RAI administration and risk factor assessments where case findings should be continuous. The Korean guidelines for thyroid cancer national-level screening were published by a relevant group of multidisciplinary thyroid experts. It was concluded that the evidence is insufficient to balance the benefits and harms of thyroid cancer screening. However, the paper seems to raise the necessary investments in future research and demand a complete analysis for derivative endpoints, and offer screening participants with complete information necessary to make decisions that will provide them with the most value when a small thyroid cancer is screen-identified.",
keywords = "Epidemiology, RAI, Screening, Surgery, Thyroid cancer",
author = "An, {J. H.} and Kim, {Hoon Yub} and Kim, {Sin Gon} and H. Dralle and Randolph, {G. W.} and E. Piantanida and Tanda, {M. L.} and G. Dionigi",
year = "2017",
month = "6",
day = "1",
doi = "10.1007/s40618-016-0596-4",
language = "English",
volume = "40",
pages = "683--685",
journal = "Journal of Endocrinological Investigation",
issn = "0391-4097",
publisher = "Editrice Kurtis s.r.l.",
number = "6",

}

TY - JOUR

T1 - Endpoints for screening thyroid cancer in the Republic of Korea

T2 - thyroid specialists’ perspectives

AU - An, J. H.

AU - Kim, Hoon Yub

AU - Kim, Sin Gon

AU - Dralle, H.

AU - Randolph, G. W.

AU - Piantanida, E.

AU - Tanda, M. L.

AU - Dionigi, G.

PY - 2017/6/1

Y1 - 2017/6/1

N2 - Cancer screening is aimed primarily at reducing deaths from the specific cancer. Thyroid-specific cancer mortality may be the most ambitious endpoint for obtaining estimates of screening effect. Numerous observations have accumulated over the years, indicating that thyroid cancer mortality endpoint has been difficult to study and is confounded by population heterogeneity, provision of randomization, and requirement of large cohorts with sufficiently long follow-up due to the excellent prognosis of the cancer. Accordingly, it may be important to reconsider how to best measure thyroid cancer screening efficacy. Recommendations against thyroid cancer screening should be based upon trials designed to evaluate its effectiveness not only in significant reduction in cancer mortality, but also of other distinct endpoints. It is desirable to evaluate derivative endpoints that can reliably predict reductions in mortality. The term “derivative” means a variable that is related to the true endpoint and is likely to be observable before the primary endpoint. Derivative endpoints may include thyroid cancer incidence, the proportion of early-stage tumors detected, more treatable stage, the identification of small tumors (to maintain in observation), decrease in the number of people who develop metastatic disease, the increased chance of lesser extent surgery, and the application of minimally invasive approaches, as well as no need for lifelong thyroid replacement therapy, a consistent follow-up, low-dose or no RAI administration and risk factor assessments where case findings should be continuous. The Korean guidelines for thyroid cancer national-level screening were published by a relevant group of multidisciplinary thyroid experts. It was concluded that the evidence is insufficient to balance the benefits and harms of thyroid cancer screening. However, the paper seems to raise the necessary investments in future research and demand a complete analysis for derivative endpoints, and offer screening participants with complete information necessary to make decisions that will provide them with the most value when a small thyroid cancer is screen-identified.

AB - Cancer screening is aimed primarily at reducing deaths from the specific cancer. Thyroid-specific cancer mortality may be the most ambitious endpoint for obtaining estimates of screening effect. Numerous observations have accumulated over the years, indicating that thyroid cancer mortality endpoint has been difficult to study and is confounded by population heterogeneity, provision of randomization, and requirement of large cohorts with sufficiently long follow-up due to the excellent prognosis of the cancer. Accordingly, it may be important to reconsider how to best measure thyroid cancer screening efficacy. Recommendations against thyroid cancer screening should be based upon trials designed to evaluate its effectiveness not only in significant reduction in cancer mortality, but also of other distinct endpoints. It is desirable to evaluate derivative endpoints that can reliably predict reductions in mortality. The term “derivative” means a variable that is related to the true endpoint and is likely to be observable before the primary endpoint. Derivative endpoints may include thyroid cancer incidence, the proportion of early-stage tumors detected, more treatable stage, the identification of small tumors (to maintain in observation), decrease in the number of people who develop metastatic disease, the increased chance of lesser extent surgery, and the application of minimally invasive approaches, as well as no need for lifelong thyroid replacement therapy, a consistent follow-up, low-dose or no RAI administration and risk factor assessments where case findings should be continuous. The Korean guidelines for thyroid cancer national-level screening were published by a relevant group of multidisciplinary thyroid experts. It was concluded that the evidence is insufficient to balance the benefits and harms of thyroid cancer screening. However, the paper seems to raise the necessary investments in future research and demand a complete analysis for derivative endpoints, and offer screening participants with complete information necessary to make decisions that will provide them with the most value when a small thyroid cancer is screen-identified.

KW - Epidemiology

KW - RAI

KW - Screening

KW - Surgery

KW - Thyroid cancer

UR - http://www.scopus.com/inward/record.url?scp=85019141935&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85019141935&partnerID=8YFLogxK

U2 - 10.1007/s40618-016-0596-4

DO - 10.1007/s40618-016-0596-4

M3 - Article

C2 - 28008561

AN - SCOPUS:85019141935

VL - 40

SP - 683

EP - 685

JO - Journal of Endocrinological Investigation

JF - Journal of Endocrinological Investigation

SN - 0391-4097

IS - 6

ER -