This probably belongs in the medical section, but worth reading none the less. What follows is one doctors opinion of x-rays and cat scans...
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S&A HEALTH REPORT: The Danger of Detection
By Dr. David Eifrig Jr.
For the past two years, I have had the pleasure of staying at the Union League in Philadelphia for a week, while attending an annual review course sponsored by the University of Pennsylvania. This year, as last year, the pressure to learn was intense. The daily lectures began at 7:15 a.m. and ended approximately 12 hours later! Lunch was provided, but often the scheduled time to eat was shortened because the morning lecture didn't end on time. Whew… I learned a lot, but most of it is still sinking in. By the way, if you ever get a chance to learn about the history of the Union League, I encourage you to do so. Its motto is "Love of Country Leads." It was founded in 1862 as a society to support President Lincoln. It is a fascinating place and the employees are about as loyal as any I have ever met. The Union League is to the movers and shakers of American politics as The Augusta National is to golf.
Okay, enough of the travel diary and on to the point. One of this year's speakers at the review course reminded us of something he said last year. I had apparently ignored it last year, but this time it hit home in a big way.
According to David Abramson, the first-ever Chief of the Ophthalmic Oncology Service at Memorial Sloan-Kettering Cancer Center, "Diagnostic X-rays cause close to 1% of all deaths in the U.S., and 3.5% of all deaths in Japan." Moreover, he told us, "You should never let a child get a CT". A CT, or computer tomography, is essentially a large number of consecutive or serial X-rays taken all at once and then analyzed by computers using fancy algorithms. This was jaw-dropping because I myself have ordered hundreds of CTs on adults and children. It turns out that terminal cancers that occur years later are not easily traced back to the earlier exposures.
Suspicions that radiation from X-rays and CTs cause long-term health problems have been around for a long time. But because the cancers are slow-growing and insidious, it has taken a long time to uncover the real risks. Only in the past 10 years have scientists truly questioned the benefits versus risks of detection via CT or X-ray.
What this means for you and me is unclear, but for us as a group the dangers are real. Researchers at Columbia University put the risk for getting cancer at 1 out of 1,000 from exposure to radiation from the now-commercially available whole-body scans. In addition, the false positive rates from these machines are high. This means that the scan finds anomalies that are not truly disease-causing or debilitating. The anomalies don't need treatment, but they show up on the scans as "positive." On top of this, these whole-body tests are usually hyped as health-promoting when, in fact, they are not. Even worse, they are expensive.
What is scary, though, is that the studies your doctor might order could easily be useless as well as dangerous. Yet, we trust our doctor to make these decisions. Be careful. Is your doctor ordering tests to help with diagnosis, or to CTA (Cover Their A**)? You see, even if the CT were to pick up a true disease entity (for example, prostate cancer), there is very little evidence that early detection in certain diseases (especially slow-growing ones) makes any difference in quality or length of life. For those with a disease detected early and no symptoms, the psychological impact of knowing you have a disease can be spiritually and physically devastating. It is possible that the psychological impact is more devastating than the disease would be, and could lead to earlier morbidity and mortality. In fact, a Mayo study of lung-cancer screening found that people in the screening group died earlier than those not screened with CTs. Hmmm.…
In a Japanese study, CT screenings flagged equal numbers of smokers and non-smokers for lung cancer. Thus, CTs failed as a screening tool for cancer in smokers, and worse, put many people at risk for cancer from the radiation exposure of the CT.
The confounding variable in all this is that doctors are taught to do things based on assigning value to a result. So ordering a test and acting on it becomes a very natural step for doctors. Sometimes they act even if the result is logically flawed. Surprisingly and dangerously, treating a false positive from a lab or test result is quite common. Ironically, the real problem comes when doctors treat a false positive and, seeing improvement, assume falsely the treatment worked.
This statistic will blow you away: After 10 yearly mammograms for women 50 years old or older, the cumulative false positive rate rises to almost 50%. What! How can this be so? Your doctor certainly won't tell you this. Does your doctor even know? And what happens is that the poor woman is exposed to more radiation and more risk of cancers as the doctor tries to figure out whether she really does have the disease. The key is to assess the risk clinically before exposing a woman to radiation. The math is slightly complicated, but by stratifying patients in to pre-test probabilities for disease…the correct and, hopefully, safest test might be ordered.
The fact is that CTs and the haphazard recommendations to get them when the clinical signs and symptoms don't warrant them are inexcusable. Just recently I read of a child getting head CTs when the clinical suspicions were quite low. The poor child's head was only exposed to the CT radiation because of the parents' prodding and the doctor's fear. Again, this is exposure that has been shown to lead to cancer, and could have been prevented by informed and fearless parents and doctors. Sadly, most doctors will argue that they have to order them to avoid being sued, commonly saying that they've never been sued for ordering a test, only for not ordering one.
When it comes to radiation... What do I do?
I avoid radiation for myself whenever possible.
I do not let dentists X-ray my mouth.
I do not get chest X-rays for a long-standing cough since I am not a cigarette smoker.
When considering a CT in a child, I think long and hard about this and discuss the very real dangers with the parents. If the clinical picture fits, the CT usually is unnecessary.
If a doctor ever recommended a CT, I would request an MRI (these are currently thought to be safer than the radiation from CTs).
Here's to our health,
David Eifrig Jr., M.D., M.B.A.
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