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Martha A. Zeiger, MD
Baltimore, Md

Arch Surg. 1998;133:1065.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

The findings reported by Yamashita et al are due to a multitude of factors. The increase in age of patients given a diagnosis of papillary thyroid cancers during 3 consecutive decades is likely secondary to the increased longevity experienced by the overall population. Two factors exist that may contribute to the decrease in tumor size seen over time: (1) ultrasonography is more readily available and thereby identifies lesions that are smaller and not obvious clinically; and (2) fine needle aspiration biopsy, introduced during the 1950s, is more universally available and also can identify cancers at an earlier stage. The improvement in disease-specific survival is probably secondary to a change in the reported overall treatment of these patients. First, by identifying lesions at an earlier stage, one introduces the concept of lead-time bias, which can contribute to perceived overall improved survival. Second, the authors report an increase . . . [Full Text of this Article]