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Stop biopsying small thyroid nodules and never screen the thyroid

South Korea's thyroid cancer rate rose 15-fold after ultrasound screening, with no fall in deaths. A firm rule not to biopsy nodules under 1 cm, and not to screen, would prevent this harm elsewhere.

Korean thyroid overdiagnosis is the clearest natural experiment in the field, and incidence fell after the 2014 public debate without any mortality change. Guidelines already discourage biopsy of sub-centimetre nodules but practice varies. Propose national policy: no ultrasound thyroid screening, mandatory adherence to size thresholds, and public reporting of the thyroid cancer incidence-to-mortality ratio as a harm indicator.

Hypothesis
Policy adoption reduces thyroid cancer incidence by at least 30% within five years with no change in thyroid cancer mortality.
Rationale
Korea showed reversibility: incidence fell rapidly once biopsy thresholds were enforced.
What would test it
Interrupted time-series in adopting regions versus controls.
Maturity
being tested at scale
Who has to act
policy
Cost to try
Small (under $1M)
Years to first evidence
4
Bottlenecks it attacks
  • Overdiagnosis and false alarms · Finding more cancer is not the same as saving lives. Screening also finds cancers that would never have hurt anyone, and treats them.

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