Adoption of Active Surveillance for Very Low-Risk Differentiated Thyroid Cancer in the United States: A National Survey

Susan C. Pitt, Nan Yang, Megan C. Saucke, Nicholas Marka, Bret Hanlon, Kristin L. Long, Alexandria D. McDow, J. P. Brito, Benjamin R. Roman

Research output: Contribution to journalArticle

12 Scopus citations


CONTEXT: Active surveillance (AS) of thyroid cancer with serial ultrasounds is a newer management option in the United States.

OBJECTIVE: This work aimed to understand factors associated with the adoption of AS.

METHODS: We surveyed endocrinologists and surgeons in the American Medical Association Masterfile. To estimate adoption, respondents recommended treatment for 2 hypothetical cases appropriate for AS. Established models of guideline implementation guided questionnaire development. Outcome measures included adoption of AS (nonadopters vs adopters, who respectively did not recommend or recommended AS at least once; and partial vs full adopters, who respectively recommended AS for one or both cases).

RESULTS: The 464 respondents (33.3% response) demographically represented specialties that treat thyroid cancer. Nonadopters (45.7%) were significantly (P < .001) less likely than adopters to practice in academic settings, see more than 25 thyroid cancer patients/year, be aware of AS, use applicable guidelines (P = .04), know how to determine whether a patient is appropriate for AS, have resources to perform AS, or be motivated to use AS. Nonadopters were also significantly more likely to be anxious or have reservations about AS, be concerned about poor outcomes, or believe AS places a psychological burden on patients. Among adopters, partial and full adopters were similar except partial adopters were less likely to discuss AS with patients (P = .03) and more likely to be anxious (P = .04), have reservations (P = .03), and have concerns about the psychological burden (P = .009) of AS. Few respondents (3.2%) believed patients were aware of AS.

CONCLUSION: Widespread adoption of AS will require increased patient and physician awareness, interest, and evaluation of outcomes.

Original languageEnglish (US)
Pages (from-to)E1728-E1737
JournalJournal of Clinical Endocrinology and Metabolism
Issue number4
StatePublished - Mar 25 2021
Externally publishedYes

Bibliographical note

Funding Information:
This work was supported by the UW Carbone Cancer Center (support grant No. P30 CA014520, principal investigator S.C.P.); the National Cancer Institute (NCI) of the National Institutes of Health (NIH) (award No. K08CA230204 to S.C.P.); and the Memorial Sloan Kettering Cancer Center (support grant No. P30 CA008748 from the NIH/NCI to B.R.R.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. In addition, the NIH did not play a role in the design or conduct of the study; data collection, management, analysis or interpretation; manuscript preparation, review, or approval; or the decision to submit the manuscript for publication.

Publisher Copyright:
© 2020 Published by Oxford University Press on behalf of the Endocrine Society 2020.


  • active surveillance
  • microcarcinoma
  • surveillance
  • survey
  • thyroid cancer

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural


Dive into the research topics of 'Adoption of Active Surveillance for Very Low-Risk Differentiated Thyroid Cancer in the United States: A National Survey'. Together they form a unique fingerprint.

Cite this