{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T13:51:16Z","timestamp":1753883476200,"version":"3.41.2"},"reference-count":13,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2019,1,1]],"date-time":"2019-01-01T00:00:00Z","timestamp":1546300800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University Health Network Thyroid Endowment Fund","award":["Not applicable"],"award-info":[{"award-number":["Not applicable"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Otolaryngology - Head &amp; Neck Surgery"],"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p> The incidence of thyroid cancer (TC) is known to be very high in the Greater Toronto Area of Ontario, Canada. We performed a pilot survey study examining Toronto-area family physician (FP) perspectives on thyroid neoplasm evaluation (i.e. thyroid nodules [TNs] or thyroid cancer [TC]) in this region, to explore for potential factors leading to overdiagnosis. <\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p> We performed a cross-sectional mail-out written survey of a random sample of 300 FPs in active practice in the Greater Toronto Area (Markham and Brampton). <\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p> The overall response rate was 22.3, 95% confidence interval (CI) 18.0, 27.4% (67\/300); the effective response rate was 19.9, 95% CI 15.7, 24.9% (58\/291), after excluding 6 FPs that reported TN evaluation was outside their scope of practice and three FPs with an invalid mailing address. There were no missing responses to questions. The demographic characteristics were as follows: 58.6% (34\/58) from Markham, 55.2% (32\/58) were female, 58.6% (34\/58) were in practice &gt;\u200910\u2009years, and 32.8% (19\/58) affiliated with a University. All FPs reported easy access to thyroid ultrasound (TUS). About half of FPs were concerned about overdiagnosis of TC and most did not believe that there was any TC survival advantage with routine screening TUS. Although appropriate indications for TUS were endorsed by most respondents (e.g. palpable TN, incidental TN on other imaging), inappropriate recommendations were observed in a third of FPs (19\/57) who recommended TUS for abnormal thyroid blood tests about half of FPs (30\/56) who endorsed biopsy of sub-centimeter nodules. About half of FPs (31\/58) reported that their patients sometimes request medically unnecessary TUS. <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p> There are likely multiple complex factors leading to potential overdiagnosis of TC in primary care, including some physicians\u2019 knowledge gaps about appropriate indications for TN investigations as well as patients\u2019 requests and expectations. <\/jats:p><\/jats:sec>","DOI":"10.1186\/s40463-019-0349-4","type":"journal-article","created":{"date-parts":[[2019,5,30]],"date-time":"2019-05-30T14:03:05Z","timestamp":1559224985000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["A pilot study examining Toronto-area family physician perspectives on thyroid neoplasm evaluation"],"prefix":"10.1177","volume":"48","author":[{"given":"Arjun","family":"Kundra","sequence":"first","affiliation":[{"name":"Division of Endocrinology, Department of Medicine, University Health Network and University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David P.","family":"Goldstein","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology and Head and Neck Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kimberly","family":"Wintemute","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sangeet","family":"Ghai","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard W.","family":"Tsang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University Health Network and University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karuna","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Donatus R.","family":"Mutasingwa","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeff","family":"Weissberger","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ella","family":"Huszti","sequence":"additional","affiliation":[{"name":"Biostatistics Research Unit, University Health Network, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick","family":"Brown","sequence":"additional","affiliation":[{"name":"Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huan","family":"Jiang","sequence":"additional","affiliation":[{"name":"Cancer Care Ontario, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4152-5578","authenticated-orcid":false,"given":"Anna M.","family":"Sawka","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Department of Medicine, University Health Network and University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2019,1,1]]},"reference":[{"key":"bibr1-s40463-019-0349-4","doi-asserted-by":"publisher","DOI":"10.9778\/cmajo.20160162"},{"key":"bibr2-s40463-019-0349-4","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.184"},{"key":"bibr3-s40463-019-0349-4","doi-asserted-by":"publisher","DOI":"10.1186\/s40463-015-0088-0"},{"key":"bibr4-s40463-019-0349-4","unstructured":"The College of Physicians and Surgeons of Ontario. Find a doctor. 2018. Available at: https:\/\/www.cpso.on.ca\/ Accessed 20 Apr 2018."},{"key":"bibr5-s40463-019-0349-4","unstructured":"Random.org. True random number generator. 2018. Available at: https:\/\/www.random.org\/ Accessed 1 May 2018."},{"key":"bibr6-s40463-019-0349-4","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.328.7452.1372"},{"key":"bibr7-s40463-019-0349-4","doi-asserted-by":"crossref","unstructured":"US Preventive Services Task Force, Bibbins-Domingo K, Grossman DC, Curry SJ, Barry MJ, Davidson KW, Doubeni CA, Epling JW Jr, Kemper AR, Krist AH, Kurth AE, Landefeld CS, Mangione CM, Phipps MG, Silverstein M, Simon MA, Siu AL, Tseng CW. Screening for Thyroid Cancer: US Preventive Services Task Force Recommendation Statement. 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