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Is Incidence of Thyroid Cancer in United States Related to Malpractice Climate?

By: Celeste L. Dixon
Posted: Monday, February 25, 2019

The authors of a PLOS One research article proposed that the dramatic rise in the incidence of thyroid cancer in the United States is “largely due to overdiagnosis, the diagnosis of tumors that would have never manifest clinically if untreated.” And overdiagnosis, they asserted, “may relate to defensive medicine”—in other words, concern about malpractice lawsuits.

Joshua I. Warrick, MD, of Pennsylvania State University’s College of Medicine in Hershey, and colleagues quantified the state-level malpractice risk in the United States as the number of malpractice payouts per 100,000 people per state per year. Then, they measured the association between state-level risk and the 1999 to 2012 incidence of five types of cancer: thyroid, breast, prostate, colon, and lung.

After accounting for other cancer risk factors including social determinants of health, the investigators found that state-level malpractice risk was significantly associated with the incidence of thyroid cancer in both univariate (P = .009) and multivariate (P < .001) analyses. However, they noted, it was not associated with the incidence of the other four cancer types.

Why the increased testing of thyroid nodules and subsequent cancer diagnoses? The team posited the tort law factor and its sequelae: “Pennsylvania, New Jersey, and New York State are among the states with the highest number of tort rulings against physicians,” they wrote. Tort law gives rise to defensive medicine, including “the practice of recommending tests or treatments that serve not to benefit the patient, but to protect the physician from being sued,” which leads to documented thyroid cancer incidence as greater in “people with higher socioeconomic status and in those residing in northeastern states near the Atlantic Ocean, particularly Pennsylvania, New Jersey, and New York State.” 

“It’s possible this is not cause and effect directly but rather a marker of culture,” added Dr. Warrick in a Penn State Health press release.

Disclosure: The study authors reported no conflicts of interest.

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