· Executive Brief
Thyroid Cancer Awareness Month 2026
A practical executive framework for access, ownership, handoffs, measurement, and improvement.
Leadership signal
Thyroid Cancer Awareness Month can serve as an executive operating checkpoint.
Awareness can generate questions and requests for help. Executive teams can prepare by clarifying the first point of contact, the qualified team that accepts the request, the handoff standard, and the method used to verify completion without assuming that one route fits every person.
Start by distinguishing what is known from what the organization still needs to learn. A campaign plan, communication volume, or meeting count does not establish that a route is usable. Leaders need direct listening, clear ownership, locally defined measures, and a method for keeping exceptions visible.
Executive opening
Thyroid nodule care is a stewardship problem as much as a detection problem
Thyroid Cancer Awareness Month is often framed as a call to find cancer earlier. For thyroid cancer, that framing is incomplete. The research summarized here shows that the larger operating challenge is matching the intensity of evaluation to actual risk, then keeping people on the route they chose.
Overdiagnosis is substantial. A validated U.S. simulation model estimated that 72% to 94% of papillary thyroid cancer cases diagnosed between 1991 and 2019 were overdiagnosed.[1] A separate registry analysis attributed 79.5% of papillary cases in women and 63.5% in men to overdiagnosis during 2000 to 2019.[2] These are population estimates, and every person with a concerning nodule still needs appropriate evaluation.
At the same time, some people fall out of follow-up, and others receive more treatment than their risk requires. In one long-standing active surveillance program, 8.6% of patients had not been seen in at least two years by the study end point.[15] In one regional registry, 94% of patients with micropapillary cancer underwent total thyroidectomy.[13] Both findings describe pathway design, not individual failure. Neither would appear on a dashboard that counts only cancers found.
This brief adds evidence on ultrasound risk stratification, biopsy stewardship, indeterminate cytology, active surveillance and follow-up measurement. It complements the route, dashboard and handoff guidance already on this page. The aim is operational. Leaders need to see where their thyroid nodule pathway spends capacity without improving outcomes, and where it quietly loses people who need follow-up.
Three questions run through the evidence. Is each nodule evaluated with an intensity that matches its risk? Does every uncertain result reach a decision owner without delay? Do patients who choose surveillance stay connected to it for years, not months? The sections that follow answer each question in operational terms, with a source cited for every figure.
Current evidence
What the research shows about burden, overdiagnosis and imaging demand
The burden of thyroid cancer is shaped as much by detection practice as by disease. The U.S. model covered adults aged 18 or older from 1991 to 2019.[1] In the U.S. simulation, the absolute rate of overdiagnosis was 13 to 17 per 100,000 women versus 3 to 5 per 100,000 men.[1] The proportion overdiagnosed was 75% to 95% for women and 63% to 90% for men.[1] That translated into 443,212 to 573,705 women and 107,804 to 154,504 men overdiagnosed over 28 years.[1]
The same model estimated that reducing ultrasonography for nonpalpable nodules by 33% would have lowered papillary cancer incidence by 17% in 2019, from 18 to 15 per 100,000.[1] The modeled change in overall mortality was less than 0.1%.[1] The authors identified an opportunity to reduce unnecessary ultrasonography referrals, particularly for nonpalpable nodules.[1]
Registry data point the same way. An analysis of national cancer registry data from 2000 to 2019 refined earlier estimates with population-specific parameters.[2] Overdiagnosis accounted for 73.9% of early-stage papillary cancer in men and 85.2% in women.[2] Incidence rose rapidly through 2014 and then stabilized, while mortality remained relatively unchanged.[2] The authors called for risk stratification in screening and management to limit overtreatment while still detecting clinically significant cancers.[2]
New sources of imaging demand keep appearing. In one academic health system, 2,523 patients prescribed a glucagon-like peptide-1 receptor agonist underwent thyroid ultrasound between 2019 and 2024.[11] Guidelines do not recommend routine nodule screening when these drugs are started.[11] In a random sample of 415 of those patients, the malignancy rate was 2.4%.[11] Most ultrasounds in that subset were ordered for thyroid nodules by the endocrinologist who prescribed the drug.[11] The authors concluded that strong clinical suspicion should govern screening.[11] Ordering governance for new imaging triggers is therefore an executive lever, not only a clinical one.
Adopting a risk system does not automatically reduce downstream procedures. After a tertiary institution adopted the American College of Radiology Thyroid Imaging Reporting and Data System (TI-RADS) in 2018, total thyroid ultrasounds fell from 10,811 to 9,112.[4] Fine-needle aspiration and surgery numbers stayed similar, and total procedure cost was higher afterward, at $4,772,158.00 versus $4,280,081.98.[4] The study included 13,156 patients across the two periods.[4] Surgically proven malignancy rate, median tumor size and stage were similar before and after.[4]
Figure 1
How often thyroid care follows the intended route
Percent of the stated patient group, as reported in each study. Values are copied from the cited studies [4], [13], [14], [15]; none is estimated.
Data note. These values come from different countries, programs and denominators, so this is an indirect comparison that shows route reliability signals, not a ranking of systems.
Limitation. Higher is not always better: high adherence is desirable, while a high total thyroidectomy share for micropapillary cancer may signal overtreatment.
Figure data (5 rows)
| Measure | Value | Population, setting and year as reported | Source |
|---|---|---|---|
| Mean adherence to scheduled surveillance ultrasound | 91% | Kuma Hospital, Japan; 1,179 patients enrolled 2005–2013; 10 follow-up examinations | [15] |
| Patients with micropapillary cancer treated with total thyroidectomy | 94% | 173 of 184 patients, regional registry, 2013–2022 | [13] |
| Adherence to TI-RADS recommendations after implementation | 69.9% | 444 of 635 patients in a subset review at one tertiary institution, 2019–2022 | [4] |
| Eligible patients choosing active surveillance | 29% | 104 of 358 patients with low-risk papillary cancer, two university hospitals, Argentina, 2014–2024 | [14] |
| Surveillance patients not seen in at least 2 years | 8.6% | 101 of 1,179 patients at the study end point, Kuma Hospital, Japan | [15] |
Continuum of care
Where the nodule pathway branches, stalls or repeats work
The thyroid nodule pathway has more branch points than most screening routes. A nodule can move to ultrasound follow-up, biopsy, repeat biopsy, molecular testing, surveillance or surgery. Each branch needs a clear owner, a defined interval and a way to see when the interval has passed. Without those three elements, nodules drift between departments with no one accountable for the next step.
Risk categories do separate cytology outcomes. In a cohort of 3,368 nodules undergoing ultrasound-guided fine-needle aspiration, malignant cytology rose from 0.0% in the lowest TI-RADS category to 6.5% in the highest.[5] Using the two highest categories as the threshold, sensitivity was 88.2% and negative predictive value was 99.1%.[5] Among intermediate and higher-risk nodules, 81.0% met the size threshold for aspiration.[5] The distribution was uneven, with 51.0% of nodules in TI-RADS 4 and 18.7% in TI-RADS 5.[5]
Nondiagnostic results create a predictable repeat-work loop. Among 139 nodules with nondiagnostic cytology and a definitive final diagnosis, 11, or 7.9%, were malignant.[6] Malignancy risk was 0% in the two lowest TI-RADS categories, 2.9% in category 3, 5.9% in category 4 and 46.2% in category 5.[6] The authors suggested that nodules in categories 1 to 3 may not require repeat biopsy, while those in categories 4 and 5 should undergo it.[6] The optimal cutoff for predicting malignancy was 5 TI-RADS points.[6]
Indeterminate cytology is the hardest handoff. Investigators reviewed 919 cytologically indeterminate nodules from 2017 to 2025.[7] For atypia of undetermined significance, malignancy risk rose from 14% to 31% to 60% across TI-RADS 3, 4 and 5.[7] For follicular neoplasm, it rose from 26% to 44% to 57%.[7] Without molecular alterations, risk stayed below 10% for both indeterminate categories in TI-RADS 3 and 4.[7] Even mutation-negative atypia nodules in TI-RADS 5 carried a 44% malignancy risk.[7] The authors stressed combining imaging category with cytology rather than relying on either alone.[7]
These findings argue for one tracking queue that holds ultrasound category, cytology result and molecular status together. When those data sit in separate systems, the next step depends on whoever happens to read the report. Time from biopsy to a documented decision should be tracked as a pathway measure, not left to individual clinic schedules. It belongs on the program dashboard because it is where patients feel the wait most.
Figure 3
Why the pathway breaks
People
- Variation in reader experience and specificity
- Patient anxiety driving surgery over surveillance
- No named owner for surveillance intervals
Process
- Repeat biopsy of low-risk nondiagnostic nodules
- Indeterminate cytology without a combined decision step
- Pediatric nodules routed through adult defaults
Technology
- Imaging, cytology and molecular results in separate systems
- Unvalidated AI tools used as replacements
- No overdue-surveillance alert
Environment
- Imaging ordered for new triggers without clinical suspicion
- Uneven local access to surveillance programs
- Low-resource settings with limited care capacity
Policy
- Risk-system adoption without adherence monitoring
- Surgery as default when surveillance is not offered
- No standard for incidental nodule letters
Measurement
- Volume counted without appropriateness
- Loss to follow-up not tracked
- No stratification by sex, age or geography
Unranked qualitative cause-and-effect diagram for the outcome in the box: Thyroid nodule care is mismatched to risk: low-risk nodules are over-evaluated while some patients are lost to follow-up Causes are assembled from the cited literature [4], [6], [9], [10], [11], [14], [15]; categories are not weighted and their order carries no meaning.
Data note. Qualitative; no frequencies are implied.
Limitation. Causes drawn from published studies may not all apply locally; validate them with frontline teams.
Figure data (6 rows)
| Category | Causes drawn from the cited literature |
|---|---|
| People | Variation in reader experience and specificity; Patient anxiety driving surgery over surveillance; No named owner for surveillance intervals |
| Process | Repeat biopsy of low-risk nondiagnostic nodules; Indeterminate cytology without a combined decision step; Pediatric nodules routed through adult defaults |
| Technology | Imaging, cytology and molecular results in separate systems; Unvalidated AI tools used as replacements; No overdue-surveillance alert |
| Environment | Imaging ordered for new triggers without clinical suspicion; Uneven local access to surveillance programs; Low-resource settings with limited care capacity |
| Policy | Risk-system adoption without adherence monitoring; Surgery as default when surveillance is not offered; No standard for incidental nodule letters |
| Measurement | Volume counted without appropriateness; Loss to follow-up not tracked; No stratification by sex, age or geography |
Access
Right-sizing access through biopsy stewardship and pediatric routing
Access in thyroid care cuts both ways. People with concerning nodules need timely evaluation, while low-risk nodules can consume ultrasound, biopsy and surgical capacity. In the implementation study, total procedure cost rose after adoption while malignancy rate, tumor size and stage stayed similar.[4] Freeing that capacity is itself an access strategy for the patients who need it most. Every unnecessary biopsy slot is a slot unavailable to someone with a suspicious finding.
Refined imaging criteria may reduce unnecessary biopsies. A prospective study at 3 hospitals enrolled 408 patients with 442 nodules classified as TI-RADS 4 or higher.[8] In temporal validation, a modified system that added contrast-enhanced ultrasound features and nodule location had an unnecessary biopsy rate of 16.7%, compared with 46.7% for standard TI-RADS.[8] Sensitivity was 87.0% versus 49.3%.[8] In the training set, the unnecessary biopsy rate was 32.9% versus 50.6%.[8] The authors noted that external validation is still pending.[8]
Real-world adherence limits the payoff from any scoring system. In the institutional subset review, adherence to TI-RADS recommendations was 69.9%, or 444 of 635 patients.[4] After implementation, 70.8% of patients had only one ultrasound, compared with 62.1% before.[4] Benefit is most likely where reporting, referral and ordering behavior change together rather than in sequence. Fewer repeat scans did not mean fewer biopsies at that institution.[4] Adherence should be reported by ordering clinician and site, not only as an institutional average.
Children need a different access lens. In a surgically treated cohort of 99 pediatric patients, 60.6% had malignant pathology.[10] Adult-based TI-RADS showed a negative predictive value of 74.4% for its lower categories and an overall missed malignancy rate of 18.3%.[10] The authors cautioned that findings may not generalize to unselected pediatric populations.[10] Only irregular margins and microcalcifications were independently associated with malignancy in that cohort.[10] Even so, pediatric nodules warrant routing to teams with pediatric expertise rather than an adult default.
Capacity planning should reflect both risks at once. A health system that over-images low-risk adults while under-routing children has an allocation problem, not only a volume problem. Scheduling rules, referral criteria and protected biopsy slots for high-risk categories are the practical tools for correcting it. Each tool should be judged by whether it shortens time to evaluation for high-risk nodules while lowering low-yield procedures.
Executive guidance · System route
Build one visible operating route for Thyroid Cancer Awareness Month.
Use this route as a discussion framework. Replace each stage with the organization’s approved process, qualified roles, current service capacity, and applicable requirements. Do not infer a clinical protocol from the observance title.
The route at a glance
- Listen
- Clarify entry
- Navigate across services
- Protect transitions
- Verify and learn
Reliability rule: Every stage needs a named owner, an observable status, an approved escalation path, and a defined signal that shows whether responsibility moved or remained unresolved.
Listen
Gather questions and friction points from people using the route, frontline teams, and community-facing staff. Separate observed barriers from assumptions.
Clarify entry
Publish a plain-language first step and identify who receives requests through each approved channel.
Navigate across services
Make the receiving service, required information, current status, and next accountable owner visible whenever the route crosses an organizational boundary.
Protect transitions
Use acknowledgment and status visibility when responsibility moves between services, locations, or organizations.
Verify and learn
Review unresolved work, repeat contacts, and avoidable handoffs. Use the findings to improve the route rather than blame individuals.
Figure 2
The system route as one flow
The five stages of the system route described in this brief, drawn as one flow with a learning loop back to the start. The stages are the page’s original executive guidance, not a clinical protocol.
Data note. Shows sequence and handoffs only; it carries no counts or rates.
Limitation. Local processes may add, merge or reorder stages under organizational policy.
Figure data (5 rows)
| Stage | What the stage requires |
|---|---|
| Listen | Gather questions and friction points from people using the route, frontline teams, and community-facing staff. Separate observed barriers from assumptions. |
| Clarify entry | Publish a plain-language first step and identify who receives requests through each approved channel. |
| Navigate across services | Make the receiving service, required information, current status, and next accountable owner visible whenever the route crosses an organizational boundary. |
| Protect transitions | Use acknowledgment and status visibility when responsibility moves between services, locations, or organizations. |
| Verify and learn | Review unresolved work, repeat contacts, and avoidable handoffs. Use the findings to improve the route rather than blame individuals. |
Equity and trust
Equity spans overdiagnosis, sex differences and care capacity
Thyroid cancer inequity rarely looks like a single gap. In the U.S. model, the absolute overdiagnosis rate was several times higher for women than for men.[1] Women are therefore more exposed to the unnecessary diagnoses and treatment-related harms that the authors hope to reduce.[1] Equity work in thyroid care therefore includes protecting people from low-value care, not only expanding access.
Globally, the pattern splits by development level. Among adolescents and young adults, the global age-standardized incidence rate rose from 0.93 to 1.59 per 100,000 between 1990 and 2021.[3] High socio-demographic index regions had the highest incidence and prevalence, while low-index regions had the highest mortality and disability-adjusted life year rates.[3] Global mortality and disability rates in this age group stayed consistently low and stable over the period.[3] The authors described a dual challenge of potential overdiagnosis in wealthier settings and gaps in timely diagnosis and care capacity in resource-limited ones.[3]
The same split can exist within one U.S. market. Well-insured patients with frequent imaging may be overdiagnosed, while uninsured or rural patients with concerning nodules may face delays. Equity review should stratify overuse signals, such as biopsy of low-risk nodules, alongside underuse signals, such as overdue follow-up. Stratifying by sex matters most, given the modeled gap in absolute overdiagnosis between women and men.
Overtreatment is part of the equity picture. In a 10-year regional registry of 342 cases, 86% of patients were female.[13] Among 184 patients with micropapillary cancer, 173 underwent total thyroidectomy and only 11 underwent lobectomy.[13] Mortality stayed relatively stable at 0 to 2 cases per year while diagnoses rose.[13] The author interpreted the pattern as a likely example of overdiagnosis and overtreatment.[13] Of 80 new cases diagnosed in 2022, 47% received adjuvant radioactive iodine.[13]
Access to active surveillance is uneven too. In Argentina, 104 of 358 patients with low-risk papillary cancer, or 29%, opted for surveillance across two university hospitals.[14] Acceptance remained similar at 25% and 30% across two study phases.[14] Over the decade, 10.6% of surveillance patients developed tumor growth of at least 3 mm.[14] Where surveillance is not offered or explained well, surgery can become the default rather than a choice. Leaders should track how often surveillance is offered, not only how often it is accepted.
Human infrastructure
Reader expertise, technology and the surveillance relationship
Ultrasound interpretation is the workforce hinge of thyroid nodule care. In a study of 332 nodules read by seven radiologists, senior readers achieved specificity of 80.0% and accuracy of 69.7%.[9] Junior readers had higher sensitivity at 66.7% but lower specificity at 64.2%.[9] A computer-aided system showed sensitivity of 53.6% and specificity of 68.4%.[9] Each reader applied the five TI-RADS ultrasound features independently.[9]
The authors concluded that the system did not outperform radiologists and could not replace human expertise.[9] They suggested it could serve as a second opinion or training support for less experienced readers.[9] Executives evaluating such tools should treat them as training and quality aids until local validation shows otherwise. That framing protects both quality and workforce development. It also keeps accountability for the final category with a qualified reader.
Reader variation also shapes procedure volume. Lower specificity means more benign nodules labeled suspicious, and those labels fill biopsy schedules. Structured reporting, peer review of TI-RADS categories and feedback on biopsy yield are practical levers. The implementation study found adherence of 69.9% even at a tertiary institution, and its authors called for further real-world research.[4] Radiology leaders can share reader-level biopsy yield privately with each reader as a coaching tool.
Active surveillance depends on a durable clinician relationship. At Kuma Hospital in Japan, 1,179 patients in a long-standing surveillance program underwent a median of 9 ultrasound examinations.[15] Mean adherence across 10 follow-up examinations was 91%.[15] Patients named detailed test results, education about surveillance and supportive, collaborative interactions with their physician as key reasons for continuing.[15] Patients were followed for up to 12.76 years, and 76, or 6.4%, had surgery for clinical reasons.[15]
Surveillance programs also need surgical capacity on standby. One cohort followed 45 patients with papillary cancers larger than 1.5 cm for a median of 4.2 years.[12] Six showed tumor volume growth, five had newly identified lymph node metastasis and nine, or 20%, moved to surgery.[12] Those nine patients had no evidence of disease a median of 3.1 years after surgery.[12] Workforce plans should name who tracks intervals, who escalates growth and who schedules surgery when triggers are met. A defined coordinator role protects continuity when individual clinicians leave or change schedules.
Executive guidance · Operating dashboard
Use a small dashboard to expose friction and ownership.
Do not publish a number until the organization defines its numerator, denominator where relevant, owner, source system, exclusions, review cadence, and limits. The candidates below are management prompts, not benchmarks or reported results.
Four operating signals
Each signal pairs an executive question with one candidate local measure, set out below.
Executive guidance · Signal
Entry-point clarity
Can people and staff identify the approved first step without searching across conflicting instructions?
- Candidate local measure
- Locally defined contact, routing, and repeat-contact signals by channel and service.
Executive guidance · Signal
Ownership reliability
Does a specific team accept each request and make its status visible?
- Candidate local measure
- Requests without an owner, aged work, transfers, and escalations using locally approved definitions.
Executive guidance · Signal
Navigation continuity
Where does ownership become unclear as people move among information, evaluation, services, and follow-through?
- Candidate local measure
- Locally defined unaccepted handoffs, repeated contacts, missing information, unresolved routes, and navigation feedback.
Executive guidance · Signal
Improvement closure
Does the organization correct recurring friction and report what changed?
- Candidate local measure
- Selected barriers, assigned actions, completion status, and post-change review.
Figure 4
The operating system behind the dashboard
The four operating signals from this brief’s dashboard, each tied to the candidate owner named in the executive scorecard, around one accountable route. Drawn from the page’s original executive guidance.
Data note. Structural diagram; no measured values.
Limitation. Owners are candidates to be confirmed locally.
Figure data (4 rows)
| Operating signal | Candidate owner |
|---|---|
| Entry-point clarity | Executive sponsor and operational lead |
| Ownership reliability | Operational owner and participating teams |
| Navigation continuity | Sending and receiving owners |
| Improvement closure | Improvement owner and executive sponsor |
Executive guidance · Handoff workflow
Close the loop across teams, settings, and partners.
A handoff is reliable only when the sending party knows who is expected to receive the work, the receiving party acknowledges responsibility, and any unresolved exception remains visible. Local policy and qualified judgment control the actual process.
How responsibility moves
Lane A
From message to accepted ownership
- Confirm the approved message and intended audience.
- Publish the actual entry point and receiving role.
- Acknowledge receipt using the locally approved method.
- Escalate when ownership or response remains unclear.
Lane B
From accepted ownership to verified follow-through
- Record the next accountable owner and visible status.
- Name the receiving service and confirm acceptance without promising a clinical determination or outcome.
- Keep unresolved work visible across boundaries.
- Confirm closure or document the continuing exception.
Executive guidance · Executive scorecard
Give leaders one view of route reliability and improvement.
The scorecard keeps review focused on decisions. Leaders should set definitions locally, examine variation without overclaiming cause, and pair quantitative signals with the experience of people who use and operate the route.
Who reviews what
- Executive sponsor and operational lead
- Operational owner and participating teams
- Sending and receiving owners
- Improvement owner and executive sponsor
Candidate owners named in the scorecard, confirmed locally.
| Operating signal | Executive question | Candidate owner | Suggested review point |
|---|---|---|---|
| Entry-point clarity | Can people and staff identify the approved first step without searching across conflicting instructions? | Executive sponsor and operational lead | At campaign launch and close |
| Ownership reliability | Does a specific team accept each request and make its status visible? | Operational owner and participating teams | At a locally defined cadence |
| Navigation continuity | Where does ownership become unclear as people move among information, evaluation, services, and follow-through? | Sending and receiving owners | At a locally defined cadence |
| Improvement closure | Does the organization correct recurring friction and report what changed? | Improvement owner and executive sponsor | Until action is verified |
Figure 5
Control points for a risk-matched thyroid nodule pathway
| Control point | Risk if missing | Owner | Evidence of control |
|---|---|---|---|
| Structured TI-RADS reporting with peer review | Reader variation inflates biopsy demand | Radiology quality lead | Quarterly category audit and biopsy yield by reader |
| Imaging appropriateness for new triggers | Low-yield ultrasounds consume capacity | Endocrinology and primary care leads | Ultrasound orders by indication with clinical suspicion documented |
| Combined imaging-cytology decision queue | Indeterminate and nondiagnostic results stall | Thyroid program navigator | Time from biopsy to documented decision |
| Pediatric routing rule | Children evaluated with adult thresholds | Pediatric service line | Share of pediatric nodules seen by pediatric-trained teams |
| Active surveillance offer and tracking registry | Eligible patients default to surgery or drop out of follow-up | Endocrine surgery and endocrinology | Surveillance acceptance, overdue intervals and escalations |
| Stratified appropriateness reporting | Overuse and underuse hidden by averages | Quality and health equity | Dashboard by sex, age, insurance and geography |
Control points derived from the cited evidence [4], [6], [7], [9], [10], [14], [15] and this brief’s executive guidance.
Data note. Each row is a control to verify, not a measured result.
Limitation. Owners and evidence of control must follow local policy and applicable requirements.
Public communication
Communicating thyroid risk without fear or false reassurance
Thyroid communication has to hold two truths at once. Many small papillary cancers are overdiagnosed, yet clinically significant cancers still need timely detection.[2] The U.S. modeling study suggests that fewer unnecessary ultrasonography referrals could reduce overdiagnosis without increasing mortality.[1] Campaign messages should reflect both points rather than urging imaging for everyone. Clinicians and communications teams should agree on that balance before the month begins, so public and clinical messages match.
Anxiety is an operational variable, not only a personal one. In the Argentine surveillance cohort, anxiety was the main reason for surgery in 66% of cases in the first study phase and 40% in the second.[14] Surveillance discontinuation rates were 19.5% and 12.6% across the two phases.[14] At the end of follow-up, 84% of cases had no evidence of disease.[14] Discontinuation is not failure in itself, but each unplanned exit is a signal worth reviewing.
What patients hear shapes whether they stay on a chosen route. Kuma patients valued detailed results and education about surveillance.[15] The authors compared the clinician to a guide who advises on options, advocates for the best path over time and reaffirms or revises the plan as conditions change.[15] The authors judged that retention and adherence were not barriers to broader implementation of surveillance.[15] That model can be built into visit templates, result letters and nurse follow-up calls.
Incidental findings need their own communication plan. When nodules are found on imaging ordered for another reason, the result letter becomes the first message a patient receives. In the subset of patients prescribed glucagon-like peptide-1 receptor agonists, 757 nodules were detected and 10.6% underwent fine-needle aspiration.[11] Plain-language result templates that explain the risk category and next step may reduce repeat calls, repeat imaging and worry. Malignancy in that subset was 2.4%, and the authors concluded that strong clinical suspicion should govern screening.[11]
Public messages for the month should give people with symptoms or concerns a clear first step. They should explain that evaluation follows risk rather than a single test. They should also describe active surveillance as a monitored option for selected patients, which both cohort studies supported as a feasible initial approach.[12][14] Every message should name the route: who to contact, what happens at the first visit and how results will be shared.
Executive guidance · 90-day plan
Turn the observance into one sustained operating change.
The time boxes below are a management framework, not a clinical timeline. Adjust them to risk, scope, governance, resources, stakeholder participation, and applicable review requirements.
Ninety days, three moves
- Days 1–30See the current route
- Days 31–60Build the reliable path
- Days 61–90Make the change visible
Days 1–30 · Listen and map
See the current route
- Name an executive sponsor and an operational owner.
- Listen to people using the route and representative frontline teams.
- Map how Thyroid Cancer Awareness Month communications connect to real entry points, owners, transitions, and escalation.
- Select one recurring barrier that the organization can responsibly address.
Days 31–60 · Design and test
Build the reliable path
- Define the trigger, receiving owner, required information, acknowledgment, escalation, and closure signal.
- Validate the design with every sending and receiving team involved.
- Test one cross-service navigation handoff and correct the point where status or ownership becomes unclear.
- Test the route in more than one representative setting or operating period where practical.
Days 61–90 · Implement and verify
Make the change visible
- Launch the redesigned route with a small set of locally defined measures.
- Review unresolved work and recurring friction using a learning approach.
- Correct implementation barriers and record who owns each remaining dependency.
- Report what changed, what evidence was reviewed, and what still requires live oversight.
Figure 6
The 90-day plan on one timeline
The 90-day plan from this brief drawn as a timeline: each action sits in the 30-day window the plan assigns it. The full wording of each action is in the figure data and in the plan above.
Data note. Time boxes are a management framework, not a clinical timeline.
Limitation. Durations are uniform 30-day windows; real tasks may span windows.
Figure data (12 rows)
| Window | Action |
|---|---|
| Days 1–30 · Listen and map | Name an executive sponsor and an operational owner. |
| Days 1–30 · Listen and map | Listen to people using the route and representative frontline teams. |
| Days 1–30 · Listen and map | Map how Thyroid Cancer Awareness Month communications connect to real entry points, owners, transitions, and escalation. |
| Days 1–30 · Listen and map | Select one recurring barrier that the organization can responsibly address. |
| Days 31–60 · Design and test | Define the trigger, receiving owner, required information, acknowledgment, escalation, and closure signal. |
| Days 31–60 · Design and test | Validate the design with every sending and receiving team involved. |
| Days 31–60 · Design and test | Test one cross-service navigation handoff and correct the point where status or ownership becomes unclear. |
| Days 31–60 · Design and test | Test the route in more than one representative setting or operating period where practical. |
| Days 61–90 · Implement and verify | Launch the redesigned route with a small set of locally defined measures. |
| Days 61–90 · Implement and verify | Review unresolved work and recurring friction using a learning approach. |
| Days 61–90 · Implement and verify | Correct implementation barriers and record who owns each remaining dependency. |
| Days 61–90 · Implement and verify | Report what changed, what evidence was reviewed, and what still requires live oversight. |
Executive guidance · Leadership close
Make Thyroid Cancer Awareness Month a starting point, not an endpoint.
Recognition matters. It becomes durable when leaders also listen, clarify the route, support the people operating it, close an identified gap, and report the result without claiming more than the evidence supports.
Leadership commitment
Make ownership visible, test the route, and report what improved.
Executive action kit · Month observance
Turn Thyroid Cancer Awareness Month into accountable action.
A practical executive framework for access, ownership, handoffs, measurement, and improvement.
Leadership focus
Use this observance to examine navigation, longitudinal ownership, and specialty-care coordination. Select one verified barrier, assign an accountable owner, and carry the improvement beyond the campaign window.
Workforce lens
Ask whether staffing, role clarity, training, tools, workload, and escalation support the people operating the information, diagnostic navigation, support, and follow-through pathway.
Patient and community lens
Make the approved first step clear. Test whether a person can move from information to an acknowledged next action without navigating conflicting instructions.
Equity and access lens
Review whether language, transportation, cost, digital access, disability, geography, or trust changes a person’s ability to complete the locally approved route.
Five-minute briefing
Inspect the operating sequence
Listen with people using the pathway, caregivers, navigation teams, clinical services, and community partners. Find one a confusing entry point, unowned transition, or unresolved navigation need, then test the locally approved route from entry through acknowledged follow-through.
- Listen
- Clarify entry
- Navigate across services
- Protect transitions
- Verify and learn
Leadership actions for this week
- Name an executive sponsor and frontline operating owner.
- Ask people using and operating the pathway where ownership becomes unclear.
- Test one representative route from first question to acknowledged next step.
- Select one barrier that can be corrected without overstating the evidence.
- Set a review date and define how completion will be verified.
Candidate measures
Define every numerator, denominator where relevant, owner, data source, exclusions, cadence, and limitation locally. These are management prompts, not external benchmarks.
- Locally defined contact, routing, and repeat-contact signals by channel and service.
- Requests without an owner, aged work, transfers, and escalations using locally approved definitions.
- Locally defined unaccepted handoffs, repeated contacts, missing information, unresolved routes, and navigation feedback.
Department readiness checklist
- The public and staff entry points match the actual approved process.
- A specific role accepts each request, referral, or escalation.
- Handoffs include acknowledgment and a visible unresolved state.
- Language, disability, digital, transportation, and trust barriers receive explicit review.
- Communications do not introduce unsupported themes, statistics, or clinical advice.
- A named leader will review what changed after the observance.
Intended audiences
- Executive and Operational Leaders
- Patient Experience and Access Leaders
Staff communication template
During Thyroid Cancer Awareness Month, our organization will connect awareness with a practical review of the information, diagnostic navigation, support, and follow-through pathway. Use approved information, identify the correct entry point, confirm ownership when work moves, protect privacy, and escalate unresolved barriers through local channels.
Community communication template
Thyroid Cancer Awareness Month is an opportunity to share trustworthy information and make the next step easier to find. Use our approved channels for information and support. If a request changes hands, our goal is to keep ownership and follow-through visible.
Measurement worksheet
- Signal
- What observable condition will show whether the route works?
- Definition
- What is included, excluded, and counted?
- Owner
- Who reviews the signal and acts on exceptions?
- Cadence
- When will leaders review it?
- Equity check
- Which differences require protected, locally appropriate review?
- Closure
- What evidence will confirm the improvement was completed?
- Editorial review
- Completed
- Source records
- 2 listed under Authoritative resources
- Review standard
- Sourced facts remain separated from original executive guidance
- Clinical boundary
- No new statistical or clinical claim was added by this action kit
Sources and content boundary
Authoritative resources
Use note: All operating models, measures, scorecard questions, and action steps are original executive guidance. This article supports leadership planning and education. It does not replace clinical judgment, emergency procedures, legal advice, professional standards, organizational policy, or applicable federal, state, and local requirements.
Peer-reviewed references
References
Fifteen peer-reviewed sources, newest first. Each was individually verified through authenticated academic research databases. Bracketed numbers in the text link here; the original executive guidance on this page carries no citations because it is guidance, not a sourced claim. Sources last checked in those databases on .
- 1.Francis DO, Davies L, Zhang Y, Arroyo N, Fernandes-Taylor S, Nordby P, et al. Overdiagnosis of Papillary Thyroid Cancer. JAMA Network Open. 2026;9(2):e2559852. https://doi.org/10.1001/jamanetworkopen.2025.59852
- 2.Zhang M, Xie D, Hu Y, Qin G, Xu W. Overdiagnosis of thyroid cancer in the United States: Improved estimates based on the SEER registries during 2000-2019. International Journal of Cancer. 2026;158(5):1215-1226. https://doi.org/10.1002/ijc.70143
- 3.Yuan M, Li Z, Wang Y, Zhu Y, Chen S, Chen L, et al. Global health inequities in thyroid cancer among adolescents and young adults from overdiagnosis to inadequate care by the socio-demographic index. Global Health Research and Policy. 2026;11(1):106-113. https://doi.org/10.1016/j.ghrp.2026.05.001
- 4.Zhao Y, Yew KX, See JY, Tan IEH, Venkatanarasimha N, Too CW, et al. Real-World Outcomes Following the Implementation of ACR TI-RADS for Evaluation of Thyroid Nodules. The Laryngoscope. 2026;136(5):2370-2378. https://doi.org/10.1002/lary.70453
- 5.Lavender I, Nandurkar D. Validation of ACR TI‐RADS for Predicting Cytological Outcomes in Thyroid Nodules: A Large FNA Cohort Study. Journal of Medical Imaging and Radiation Oncology. 2026:1. https://doi.org/10.1111/1754-9485.70207
- 6.Waters L, Cullen TM, Goldstein MB, Sheth S, Slywotzky C, Islam S, et al. Utility of ACR TI-RADS to determine need for repeat FNA in thyroid nodules with nondiagnostic cytology. Cancer Cytopathology. 2026;134(5):e70093. https://doi.org/10.1002/cncy.70093
- 7.Zhao J, Abi‐Raad R, Pai SI, Langdon J, Wang M, Cai G, et al. Adjusted Risk Stratification of Indeterminate Thyroid Nodules Using the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI‐RADS). Cancer Medicine. 2026;15(9):1-11. https://doi.org/10.1002/cam4.72215
- 8.Wang S, Shi X, Ren H, Yi R, Yang Q, Gou T, et al. ACR TI-RADS Modified by CEUS Features and Nodule Location for Diagnosis and Biopsy Decision in Thyroid Nodules of TR4 or Higher. Journal of Ultrasound in Medicine. 2026. https://doi.org/10.1002/jum.70491
- 9.Zavariz JD, Silva Marques VR, Bordini A, Leitão L, Paiva Marques Lima Torres A, de Marqui Moraes PH, et al. Performance of artificial intelligence versus radiologists in ACR TI-RADS stratification of thyroid nodules: An ultrasound-based comparative study. WFUMB Ultrasound Open. 2026;4(2). https://doi.org/10.1016/j.wfumbo.2026.100114
- 10.Edri N, Tsur N, Hod R, Robenshtok E, Bachar G, Yaniv D, et al. Diagnostic Performance of ACR TI-RADS and Sonographic Predictors of Malignancy in Pediatric Thyroid Nodules. Endocrine Practice. 2026;32(9):1340-1346. https://doi.org/10.1016/j.eprac.2026.05.004
- 11.Raghunathan R, Jacobs A, Gajic Z, Castiglioni S, Dawood N, Arthurs L, et al. Overscreening of patients on glucagon-like peptide-1 receptor agonists: A second “epidemic” of thyroid cancer overdiagnosis?. Surgery. 2026;189. https://doi.org/10.1016/j.surg.2025.109868
- 12.Sanchez LP, Hintze J, Newman SK, Shaha A, Morris LG, Tuttle RM. Active Surveillance in Papillary Thyroid Cancer With Primary Tumors Greater Than 1.5 cm. Head & Neck. 2026;48(10):2669-2676. https://doi.org/10.1002/hed.70279
- 13.Othman RT. Overdiagnosis and Overtreatment of Thyroid Cancer, a Single City Experience in the Kurdistan Region/Iraq. Asia-Pacific Journal of Clinical Oncology. 2026;22(3):457-463. https://doi.org/10.1111/ajco.70054
- 14.Smulever A, Pitoia F. A decade of active surveillance for low-risk papillary thyroid carcinoma in Argentina: persistent challenges in acceptance and discontinuation rates. Endocrine. 2025;89(2):497-507. https://doi.org/10.1007/s12020-025-04296-7
- 15.Davies L, Chang CH, Sirovich B, Tuttle RM, Fukushima M, Ito Y, et al. Thyroid Cancer Active Surveillance Program Retention and Adherence in Japan. JAMA Otolaryngology-Head & Neck Surgery. 2021;147(1):77-84. https://doi.org/10.1001/jamaoto.2020.4200
Claim-to-source matrix
What each source supports
Every sourced claim in the new sections maps to the references that support it, the section where it is used, and the limitation a reader should keep in mind. Original executive guidance carries no sources because it is guidance, not a finding.
| Claim group | Sources | Years | Used in | Limitation |
|---|---|---|---|---|
| Papillary thyroid cancer overdiagnosis is substantial and higher in absolute terms for women | [1] [2] | 2026 | Current evidence | Simulation and registry-based estimates rely on modeling assumptions and cannot identify which individual cases were overdiagnosed. |
| New imaging triggers and risk-system adoption do not automatically lower procedures | [4] [11] | 2026 | Current evidence | Single-institution observational studies; cost totals are not adjusted for case mix or inflation. |
| TI-RADS category stratifies cytology, nondiagnostic and indeterminate risk | [5] [6] [7] | 2026 | Continuum of care | Retrospective cohorts selected by biopsy or surgery; malignancy risk may be overstated relative to all nodules. |
| Refined criteria and adherence determine biopsy volume | [4] [8] | 2026 | Access | Modified system awaits external validation; adherence measured in a subset at one institution. |
| Adult TI-RADS performs less well in children | [10] | 2026 | Access | Tertiary, surgically managed pediatric cohort; may not generalize to unselected children. |
| Inequity spans overdiagnosis in high-resource settings and inadequate care in low-resource settings | [1] [3] [13] [14] | 2026, 2025 | Equity and trust | Ecological global data and single-region registry; associations do not establish mechanisms. |
| Reader expertise and AI tools shape stratification quality | [9] | 2026 | Human infrastructure | Retrospective single-dataset comparison of one commercial system and seven readers. |
| Surveillance retention depends on relationship, information and anxiety management | [12] [14] [15] | 2026, 2025, 2021 | Public communication | Program-level cohorts in Japan, Argentina and one specialty cohort; cultural and system context differs from many U.S. settings. |
About the author
Greg Wahlstrom
MBAHCM
President and Chief Executive Officer, The Healthcare Executive
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