The BMJ's video: Use of imaging tests after primary treatment of thyroid cancer in the United States

Read the full open access article: http://www.bmj.com/content/354/bmj.i3839 Differentiated thyroid cancer has been increasing in incidence for several decades and is expected to be the fourth leading cancer diagnosis by the year 2030. Most of this rise in incidence is explained by diagnoses of small, low risk cancers. These low risk cancers are associated with an excellent long term survival; disease specific survival at 10 years for patients diagnosed with low risk thyroid cancer is between 96% to 100%. Yet, despite this increase in low risk cancers, our previous work found that the use of imaging tests after primary treatment of thyroid cancer is rising. However, despite no evidence for survival benefit, there are costs, potential radiation exposure, and potential downstream treatment risks associated with imaging after primary treatment. Therefore, the rising use of imaging after primary treatment necessitates further inquiry into the effects on patient outcomes, including treatment for recurrence and disease specific survival. We set out to determine whether the use of imaging tests after primary treatment of differentiated thyroid cancer is associated with more treatment for recurrence and fewer deaths from the disease. We found that the marked rise in use of imaging tests after primary treatment of differentiated thyroid cancer has been associated with an increased treatment for recurrence. However, with the exception of radioiodine scans in presumed iodine avid disease, this association has shown no clear improvement in disease specific survival. These findings emphasize the importance of curbing unnecessary imaging and tailoring imaging after primary treatment to patient risk.