INTRODUCTION
Obesity is a well-established risk factor for numerous diseases,
including different types of cancer [1, 2]. Various studies and
meta-analyses have observed an increase in the incidence of
differentiated thyroid cancer in overweight and obese individuals
[3]. Additionally, it has been suggested that obesity is associated
to more aggressive forms of papillary cancer [4], to more advanced
stages at diagnosis [5] and to higher rates of disease persistence
after treatment [6]. However, these associations have not been
replicated in other studies [7 ].
Ultrasound screening of thyroid cancer is not recommended in
asymptomatic individuals with no specific risks for the disease [8],
however, some controversy exists about the benefits and risks of the
screening in high risk populations such as radiation exposure [9,
10] and autoimmune thyroid diseases [11]. Obesity may be also
considered a risk factor for thyroid cancer [12], and although the
screening of thyroid cancer in obese individuals is not considered
justified [13], data about the feasibility of early detection of
thyroid cancer by systematic ultrasound assessment and its effects on
the prognosis of thyroid cancer in patients with obesity are lacking
[13].
In order to justify a specific cancer screening approach, it must be
demonstrated that it is beneficial, that it lacks of significant harm
and that it is cost-effective [14]. Recently, Cham et al [15],
evaluated the cost-effectiveness of US screening of thyroid cancer in
obese individuals. In their study, using data from published reports and
US costs, the authors concluded that US screening of thyroid cancer in
selected obese patients with risk factors (family history of thyroid
cancer, radiation exposure, Hashimoto’s thyroiditis, and/or elevated
thyrotropin (TSH)) was cost-effective. However, the study was based on
published reports and has not been experimentally validated in actual
obese patients.
The objective of the current study is to evaluate if a strategy of US
screening of thyroid nodules in obese patients with risk factors, can be
validated in a real clinical setting.