DOI: 10.1177/00031348261460478 ISSN: 0003-1348

Gender Disparities in Thyroid Cancer Diagnosis: Evaluating Detection Bias and Clinical Implications

Paul Brosnihan, Chantal J. Creighton, Brian Yu, Kathryn T Chen
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Background

Despite a female preponderance in clinical diagnoses, meta-analyses of autopsy studies demonstrate similar rates of subclinical thyroid cancer between sexes. This study examines granular demographic, clinical, and pathologic data to evaluate this discordance.

Methods

A single-center retrospective review (2015-2021) identified 195 thyroid cancer patients. Logistic regression models assessed demographics, presenting symptoms, pathology, recurrence, and mortality as factors in stage of presentation.

Results

Men presented with significantly larger nodules than women (median 4.45 cm vs 3.2 cm, P = 0.003 ), particularly when symptomatic ( P = 0.011 ). However, nodule size did not differ in asymptomatic patients ( P = 0.45 ). No significant differences were observed in BMI, age, prior radiation history, or ethnicity. Primary care status approached significance, with 42.5% of men lacking a documented primary care physician visit vs 24.5% of women ( P = 0.067 ). Women were more likely to have small, localized tumors ( P = 0.048 ), T1 disease ( P = 0.035 ), and stage 1 disease ( P < 0.001 ), while metastatic disease was more common in men (22.5% vs 5%, P < 0.001 ). Women were also more likely to be diagnosed with an incidental thyroid cancer when undergoing thyroidectomy for non-cancer indication. No differences in recurrence or mortality were found. Multivariate logistic regression revealed that visiting a PCP within 1 year of diagnosis was protective against advanced disease (OR:0.59, 95% CI:0.41-0.84, P = 0.003 ).

Conclusion

Women are more frequently diagnosed with subclinical and incidentally identified early-stage thyroid cancer and smaller thyroid nodules, whereas men present with larger nodules and more advanced disease. Men were also less likely to have had routine primary care visits. These findings suggest that diagnostic bias and healthcare access disparities may contribute to gender differences in thyroid cancer detection.

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