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Grant Details

Grant Number: 5R01CA251566-04 Interpret this number
Primary Investigator: Francis, David
Organization: University Of Wisconsin-Madison
Project Title: Estimating and Mitigating Thyroid Cancer Overdiagnosis: a Mathematical Modeling Approach
Fiscal Year: 2023


Project Summary/Abstract This proposal will generate evidence to reduce the overdiagnosis of thyroid cancer in the United States. Overdiagnosis is the identification of a disease that, had it not been detected, would be unlikely to cause symptoms or death during a patient’s lifetime. Overdiagnosis has significant consequences, such as overtreatment with associated side effects and complications, patient anxiety, and increased healthcare costs. Despite a three-fold increase in thyroid cancer diagnoses since the late 1980s, the mortality rate remains stable. Small papillary thyroid cancers, which are rarely lethal, are responsible for virtually the entire increase in incidence. However, it is not safe to assume that all small thyroid cancers are overdiagnosed; some small thyroid cancers can be aggressive and do need treatment. Effective methods are urgently needed to understand the key factors contributing to thyroid cancer overdiagnosis, so that directed solutions can be developed and implemented to reduce overdiagnosis. We propose the innovative use of systems engineering and simulation modeling to address this knowledge gap and provide a nuanced understanding of the natural history of thyroid tumors. We will use our model to identify the effect of reducing referrals for and use of thyroid imaging on overdiagnosis; the effect of changing the size threshold for biopsy on overdiagnosis; and the downstream impact of reducing overdiagnosis on harms and benefits of treatment. This approach also accounts for differential use and improved precision of ultrasound over time. Our goal is to create and validate a simulation model that quantifies overdiagnosis in thyroid cancer. We will engage stakeholders at all stages of development, from model conception to validation, to elicit clinical guidance and inform our model inputs, outcomes, and dissemination strategies. Our research team comprises an industrial-systems engineer with expertise in cancer modeling, as well as experts in thyroid cancer, cancer epidemiology, health services research, and communication. The multidisciplinary team is highly qualified to complete the three specific aims: (1) Develop and validate a simulation model to quantify overdiagnosis of thyroid cancer in the US; (2) Identify healthcare utilization patterns (e.g., provider encounters and referral decisions) that expose patients to increased thyroid imaging, biopsies, and the overdiagnosis of thyroid cancer; (3) Engage key stakeholders throughout the duration of the project to ensure that the model has face validity, and that the output can be applied to questions important to both clinicians and policy makers. The proposed research aligns with the National Cancer Institute’s mission to help people live longer and healthier lives. Results from this innovative model will help to inform clinical practice guidelines and referral practice recommendations to improve the quality of health care, while reducing inappropriate testing, to minimize overdiagnosis and overtreatment.


Modeling Thyroid Cancer Epidemiology in the United States Using Papillary Thyroid Carcinoma Microsimulation Model.
Authors: Alagoz O. , Zhang Y. , Arroyo N. , Fernandes-Taylor S. , Yang D.Y. , Krebsbach C. , Venkatesh M. , Hsiao V. , Davies L. , Francis D.O. .
Source: Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research, 2024 Mar; 27(3), p. 367-375.
EPub date: 2023-12-22.
PMID: 38141816
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Association between Estrogen Exposure and Idiopathic Subglottic Stenosis.
Authors: Nanda N. , Huang L.C. , Chen S.C. , Berry L.D. , Talatala E.R.R. , Clark E. , Ye W. , Gelbard A. , Francis D.O. , North American Airway Collaborative .
Source: The Laryngoscope, 2024 Feb; 134(2), p. 825-830.
EPub date: 2023-09-05.
PMID: 37668331
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Rates of Detecting Thyroid Nodules Recommended for Biopsy with Ultrasound: Are All Indications Equal?
Authors: Kennedy E. , Zhang Y. , Qadadha Y. , Cheng C. , Adil A. , Bach K. , Smith D. , Arroyo N. , Fernandes-Taylor S. , Gettle L.M. , et al. .
Source: Thyroid : official journal of the American Thyroid Association, 2023 Dec; 33(12), p. 1434-1440.
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Impact of Serial Intralesional Steroid Injections on Idiopathic Subglottic Stenosis.
Authors: Hoffman M.R. , Patro A. , Huang L.C. , Chen S.C. , Berry L.D. , Gelbard A. , Francis D.O. , North American Airway Collaborative .
Source: The Laryngoscope, 2023 Sep; 133(9), p. 2255-2263.
EPub date: 2022-10-26.
PMID: 36286239
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Diagnostic Accuracy of Fine-Needle Biopsy in the Detection of Thyroid Malignancy: A Systematic Review and Meta-analysis.
Authors: Hsiao V. , Massoud E. , Jensen C. , Zhang Y. , Hanlon B.M. , Hitchcock M. , Arroyo N. , Chiu A.S. , Fernandes-Taylor S. , Alagoz O. , et al. .
Source: JAMA surgery, 2022-12-01; 157(12), p. 1105-1113.
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Prevalence of Subclinical Papillary Thyroid Cancer by Age: Meta-analysis of Autopsy Studies.
Authors: Arroyo N. , Bell K.J.L. , Hsiao V. , Fernandes-Taylor S. , Alagoz O. , Zhang Y. , Davies L. , Francis D.O. .
Source: The Journal of clinical endocrinology and metabolism, 2022-09-28; 107(10), p. 2945-2952.
PMID: 35947867
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Complication Rates of Total Thyroidectomy vs Hemithyroidectomy for Treatment of Papillary Thyroid Microcarcinoma: A Systematic Review and Meta-analysis.
Authors: Hsiao V. , Light T.J. , Adil A.A. , Tao M. , Chiu A.S. , Hitchcock M. , Arroyo N. , Fernandes-Taylor S. , Francis D.O. .
Source: JAMA otolaryngology-- head & neck surgery, 2022-06-01; 148(6), p. 531-539.
PMID: 35511129
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Letter to the Editor: Sensitivity of Palpation for Detection of Thyroid Nodules with Attention to Size.
Authors: Hsiao V. , Arroyo N. , Fernandes-Taylor S. , Chiu A.S. , Davies L. , Francis D.O. .
Source: Thyroid : official journal of the American Thyroid Association, 2022 May; 32(5), p. 599-601.
EPub date: 2022-04-11.
PMID: 35216527
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Impact of Adjuvant Medical Therapies on Surgical Outcomes in Idiopathic Subglottic Stenosis.
Authors: Hoffman M.R. , Patro A. , Huang L.C. , Chen S.C. , Berry L.D. , Gelbard A. , Francis D.O. , North American Airway Collaborative .
Source: The Laryngoscope, 2021 Dec; 131(12), p. E2880-E2886.
EPub date: 2021-06-12.
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Evaluation of Gender Inequity in Thyroid Cancer Diagnosis: Differences by Sex in US Thyroid Cancer Incidence Compared With a Meta-analysis of Subclinical Thyroid Cancer Rates at Autopsy.
Authors: LeClair K. , Bell K.J.L. , Furuya-Kanamori L. , Doi S.A. , Francis D.O. , Davies L. .
Source: JAMA internal medicine, 2021-10-01; 181(10), p. 1351-1358.
PMID: 34459841
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Why are there different conclusions about thyroid cancer mortality?
Authors: Davies L. .
Source: Head & neck, 2021 Mar; 43(3), p. 984-986.
EPub date: 2020-12-12.
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