Health-care inefficiencies
There is growing evidence that whereas individuals, social groups, and populations with lower socioeconomic conditions have higher cancer mortality rates because of limited access or a lack of access to health-care services, those with higher access to the health system often experience the detrimental effects of too much medical care (the inverse care law).
This paradoxical situation occurs in many health systems today, some of which are facing relevant resource constraints. Too much medical care is defined as care that provides minimal or no benefit to the individual. Overdiagnosis, overtreatment, and low-value care expose individuals to the risk of major adverse effects and the health system to substantial financial costs, with minimal or no benefits. Given the increasing size of the problem, failure to recognize and control it affects all citizens. Resources and efforts are focused on unnecessary practices and potentially harmful treatments, instead of being available for the prevention and treatment of more threatening cancers and diseases, therefore precluding the reduction of social inequalities in cancer and the sustainability of health systems.
Description of the work
The aim of this work area is to identify and quantify inefficiencies in the health system that occur on a large scale, predominantly overdiagnosis and overtreatment of cancer. The main objectives are to use high-quality surveillance data to study the epidemiological features of overdiagnosis for relevant cancer types, and to develop quantitative epidemiological methods to estimate overdiagnosis and overtreatment at the global, regional, national, and subnational levels. Overdiagnosis may explain a large fraction of the rapid increases and geographical inequalities in the incidence rates (without corresponding changes in the mortality rates) of certain cancer types, such as thyroid cancer. Another objective is to estimate the economic costs associated with overdiagnosis and overtreatment, whenever possible.
The specific objectives are:
a. Quantify overdiagnosis and overtreatment of thyroid cancer, globally and at the national level;
b. Develop epidemiological methods to quantify overdiagnosis at the population level;
c. Describe the epidemiological features of overdiagnosis;
d. Quantify the economic costs of overtreatment associated with cancer overdiagnosis in specific countries and settings;
e. Assess the possible impact of overdiagnosis of prostate cancer, melanoma, kidney cancer, and breast cancer.
Changes in the incidence rate of thyroid cancer by age and period, in women in France
Team, collaborators, and related links
Principal Investigator: Salvatore Vaccarella, IARC
Margherita Pizzato, IARC
Luigino Dal Maso, Aviano Cancer Center, Italy
Meng Meng Li, Sun Yat-sen University, China
Louise Davies, The Dartmouth Institute, USA
Juan P. Brito, Mayo Clinic, USA
Anssi Auvinen, Tampere University, Finland
This work area is conducted in collaboration with the IARC project Thyroid Monitoring after Nuclear Accidents (TM-NUC), which develops recommendations for thyroid monitoring in populations possibly affected by radiation exposure due to nuclear accidents.
Selected publications
Pizzato M, Li M, Vignat J, Laversanne M, Singh D, La Vecchia C, et al. (2022). The epidemiological landscape of thyroid cancer worldwide: GLOBOCAN estimates for incidence and mortality rates in 2020. Lancet Diabetes Endocrinol. 10(4):264–72. https://doi.org/10.1016/S2213-8587(22)00035-3 PMID:35271818
Li M, Delafosse P, Meheus F, Borson-Chazot F, Lifante J-C, Simon R, et al.; Thyroid Cancer Group FRANCIM (2021). Temporal and geographical variations of thyroid cancer incidence and mortality in France during 1986–2015: the impact of overdiagnosis. Cancer Epidemiol. 75:102051. https://doi.org/10.1016/j.canep.2021.102051 PMID:34743057
Li M, Zheng R, Dal Maso L, Zhang S, Wei W, Vaccarella S (2021). Mapping overdiagnosis of thyroid cancer in China. Lancet Diabetes Endocrinol. 9(6):330–2. https://doi.org/10.1016/S2213-8587(21)00083-8 PMID:33891886
Miranda-Filho A, Lortet-Tieulent J, Bray F, Cao B, Franceschi S, Vaccarella S, et al. (2021). Thyroid cancer incidence trends by histology in 25 countries: a population-based study. Lancet Diabetes Endocrinol. 9(4):225–34. https://doi.org/10.1016/S2213-8587(21)00027-9 PMID:33662333
Vaccarella S, Lortet-Tieulent J, Colombet M, Davies L, Stiller CA, Schüz J, et al.; IICC-3 contributors (2021). Global patterns and trends in incidence and mortality of thyroid cancer in children and adolescents: a population-based study. Lancet Diabetes Endocrinol. 9(3):144–52. https://doi.org/10.1016/S2213-8587(20)30401-0 PMID:33482107
Vaccarella S, Dal Maso L (2021). Challenges in investigating risk factors for thyroid cancer. Lancet Diabetes Endocrinol. 9(2):57–9. https://doi.org/10.1016/S2213-8587(20)30426-5 PMID:33347808
Li M, Dal Maso L, Vaccarella S (2020). Global trends in thyroid cancer incidence and the impact of overdiagnosis. Lancet Diabetes Endocrinol. 8(6):468–70. https://doi.org/10.1016/S2213-8587(20)30115-7 PMID:32445733
Vaccarella S, Davies L (2019). The inverse care law: overutilization of health services and overdiagnosis. In: Vaccarella S, Lortet-Tieulent J, Saracci R, Conway DI, Straif K, Wild CP, editors. Reducing social inequalities in cancer: evidence and priorities for research (IARC Scientific Publications No. 168). Lyon, France: International Agency for Research on Cancer; pp. 245–9. Available from: https://publications.iarc.fr/580.
Vaccarella S, Franceschi S, Bray F, Wild CP, Plummer M, Dal Maso L (2016). Worldwide thyroid-cancer epidemic? The increasing impact of overdiagnosis. N Engl J Med. 375(7):614–7. https://doi.org/10.1056/NEJMp1604412 PMID:27532827
Funding
Institut National du Cancer (INCa), France