{"entity":{"id":"idea-prev-ptmc-active-surveillance-default","kind":"idea","name":"Active surveillance as the default for tiny papillary thyroid cancers","aka":[],"tldr":"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.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (Overdiagnosis and false alarms): Welch & Black, Overdiagnosis in cancer (JNCI 2010)","url":"https://doi.org/10.1093/jnci/djq099"}],"tags":[],"related":[],"cancers":["thyroid"],"sections":["early-detection"],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":["jfcr"],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-overdiagnosis"],"keyPapers":["paper-welch-j-natl-cancer-inst"],"journals":[],"dependsOn":[],"notes":[],"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.","test":"Registry-based comparison plus a randomised decision-aid trial on uptake of surveillance.","maturity":"being-tested-at-scale","actor":"clinic","cost":"small","horizonYears":3},"route":"/ideas/idea-prev-ptmc-active-surveillance-default/","neighbours":{"cancer":[{"id":"thyroid","kind":"cancer","name":"Thyroid cancer","route":"/cancers/thyroid/"}],"section":[{"id":"early-detection","kind":"section","name":"Early Detection & Screening","route":"/fronts/early-detection/"}],"institution":[{"id":"jfcr","kind":"institution","name":"Cancer Institute Hospital of JFCR","route":"/institutions/jfcr/"}],"bottleneck":[{"id":"b-overdiagnosis","kind":"bottleneck","name":"Overdiagnosis and false alarms","route":"/bottlenecks/b-overdiagnosis/"}],"paper":[{"id":"paper-welch-j-natl-cancer-inst","kind":"paper","name":"Overdiagnosis in cancer","route":"/key-papers/paper-welch-j-natl-cancer-inst/"}]}}