# Active surveillance as the default for tiny papillary thyroid cancers

Source: https://onco.cc/ideas/idea-prev-ptmc-active-surveillance-default/  
OnCo record `idea-prev-ptmc-active-surveillance-default` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Papillary thyroid cancers under 1 cm almost never cause harm. Japanese hospitals have watched thousands safely. Make watching, not surgery, the default everywhere, with a registry.

## Summary

Kuma Hospital and Cancer Institute Hospital (Tokyo) cohorts show under 1% distant progression and no disease deaths over decades of surveillance for low-risk papillary microcarcinoma. Propose making surveillance the default option in guidelines, with an international registry, a standardised ultrasound protocol, and reimbursement parity with surgery.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Default surveillance reduces surgery for papillary microcarcinoma by at least 60% with disease-specific mortality unchanged and lower rates of hypoparathyroidism and nerve injury.
- Rationale: Long-term Japanese outcomes have been replicated in US and Korean pilots.
- Proposed test: Registry-based comparison plus a randomised decision-aid trial on uptake of surveillance.
- Maturity: being-tested-at-scale
- Actor: clinic

## Sources

- Bottleneck evidence (Overdiagnosis and false alarms): Welch & Black, Overdiagnosis in cancer (JNCI 2010): https://doi.org/10.1093/jnci/djq099

## Connected records

- cancers: [Thyroid cancer](https://onco.cc/cancers/thyroid/)
- fronts: [Early Detection & Screening](https://onco.cc/fronts/early-detection/)
- institutions: [Cancer Institute Hospital of JFCR](https://onco.cc/institutions/jfcr/)
- bottlenecks: [Overdiagnosis and false alarms](https://onco.cc/bottlenecks/b-overdiagnosis/)
- key papers: [Overdiagnosis in cancer](https://onco.cc/key-papers/paper-welch-j-natl-cancer-inst/)

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