{"entity":{"id":"idea-prev-thyroid-no-screening-no-small-biopsy","kind":"idea","name":"Stop biopsying small thyroid nodules and never screen the thyroid","aka":[],"tldr":"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.","summary":"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.","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":["ultrasound"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-overdiagnosis"],"keyPapers":["paper-welch-j-natl-cancer-inst"],"journals":[],"dependsOn":[],"notes":[],"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.","test":"Interrupted time-series in adopting regions versus controls.","maturity":"being-tested-at-scale","actor":"policy","cost":"small","horizonYears":4},"route":"/ideas/idea-prev-thyroid-no-screening-no-small-biopsy/","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/"}],"technology":[{"id":"ultrasound","kind":"technology","name":"Ultrasound","route":"/technologies/ultrasound/"}],"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/"}]}}