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Ultrasound restraint and surveillance to reverse thyroid cancer overdiagnosis

Most thyroid cancers found today would never have hurt anyone. Screen less, watch small ones, and operate only when they grow.

Incidence tripled in many countries since the 1990s with flat mortality; South Korea's screening-driven epidemic reversed when screening was discouraged. Active surveillance for microcarcinoma and TI-RADS-based biopsy thresholds are the tools.

Hypothesis
Health systems adopting TI-RADS biopsy thresholds and active surveillance for ≤1 cm papillary cancers can halve thyroidectomy rates without increasing thyroid cancer mortality.
Rationale
Autopsy studies find occult papillary cancer in up to a third of adults; Kuma Hospital and MSK cohorts show safety of surveillance.
What would test it
Regional registry comparisons before and after policy change (South Korea already provides a natural experiment); prospective surveillance cohorts outside Asia.
Maturity
being tested at scale

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