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To the Editor: In their study of the increasing incidence of thyroid cancer in the United States between 1973 and 2002, Drs Davies and Welch¹ concluded that the increase was artifactual, due to increasing detection of small thyroid nodules. We believe that this conclusion is premature. Use of imaging technology for the thyroid may have begun increasing in the early 1980s, but workup for thyroid disease generally occurs because of symptoms or signs. We are not aware of any organized, concerted, sustained effort in thyroid cancer screening.

Davies and Welch observed the greatest increase in incidence for cancers less than 1 cm in diameter, but they show that tumors of 1 to 2 cm and 2 to 5 cm in diameter have also been strongly increasing in incidence. Nodules about 1 cm in diameter are detectable by palpation, and those 2 to 5 cm in diameter are frequently visually apparent . . . [Full Text of this Article]

Yawei Zhang, MD, PhD; Yong Zhu, PhD; Harvey A. Risch, MD, PhD
harvey.risch@yale.edu
Department of Epidemiology and Public Health
Yale University School of Medicine
New Haven, Conn

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