The Associated Press has run a couple of great articles this week about the health risks associated with getting too many medical tests.
It’s a topic Americans seem to have difficulty discussing rationally.
Our leading source of radiation
On Monday, AP medical writer Marilynn Marchione reported on how we get too much radiation — not, as she noted, from airport scanners, power lines, cell phones or even microwaves, but from our excessive use of medical tests.
“Americans get the most medical radiation in the world, even more than folks in other rich countries,” Marchione wrote. “The U.S. accounts for half of the most advanced procedures that use radiation, and the average American’s dose has grown sixfold over the last couple of decades.”
Too much radiation poses a serious cancer risk. “Radiation is a hidden danger — you don’t feel it when you get it, and any damage usually doesn’t show up for years,” writes Marchione. “Taken individually, tests that use radiation pose little risk. Over time, though, the dose accumulates.”
Of course, no one is saying radiation scans are never necessary. They save many, many lives. But, as Marchione points out, research suggests that a third of all CT scans are given when other, safer options were available. As a result of their overuse, CT scans may put 20 million adults — and more than 1 million children — needlessly at risk of developing cancer each year.
As reported here in Second Opinion last December, the authors of one study estimated that 15,000 people may die from cancer over the next two decades as a direct result of the CT scans they received in 2007 alone.
Marchione reports that the U.S. Food and Drug Administration (FDA) may finally be doing something about all this accumulative radiation. In interviews, FDA officials “described steps in the works, including possibly requiring device makers to print the radiation dose on each X-ray or other image so patients and doctors can see how much was given,” she writes. “The FDA also is pushing industry and doctors to set standard doses for common tests such as CT scans.”
“We are considering requirements and guidelines for record-keeping of dose and other technical parameters of the imaging exam,” Sean Boyd, chief of the FDA’s diagnostic devices branch, told Marchione.
One of the agency’s initial goals is to develop a “radiation medical record” to track a patient’s radiation dose from cradle to grave.
You can read Marchione’s entire article here. It includes an eye-opening list of the reasons for the overuse of radiation scans (we patients are a big part of the problem) and a helpful lists of questions you can ask your doctor to make sure any radiation scan being suggested for you is actually needed.
The dilemma of finding cancers too early
The second AP article discusses how cancer screening leads to the overdiagnosis and overtreatment of early cancers. Writes reporter Lauran Neergaard:
It’s an unthinkable notion for a generation raised on the message that early cancer detection saves lives, but specialists say more tumors actually are being found too early. That is raising uncomfortable questions about how aggressively to treat early growths—in some cases, even how aggressively to test. …
“The message has been, ‘Early detection, early detection, early detection.’ That’s true for some things but not all things,” said Dr. Laura Esserman, a breast cancer specialist at [University of California, San Francisco]. She helped lead a study, reported last week, that found mammography is increasing diagnoses of tumors deemed genetically very low risk.
“It’s not just about finding any cancer. It’s about being more discriminating when you do find it,” she added.
Today’s cancer screenings can unearth tumors that scientists say never would have threatened the person’s life. … “We’re really at a tipping point right now, where we have a trade-off between the benefits of finding cancer early and the harms that are caused,” said Dr. Len Lichtenfeld of the American Cancer Society. “We treat more patients than we know will benefit. …We just don’t know who they are.”
It’s because of that uncertainly, of course, that health consumers need to become better educated about the potential risks as well as the potential benefits of cancer screening so that they can make wise, individualized decisions about whether or not to have such a test.
Here’s how Dr. Susan Love, a breast surgeon and researcher in Santa Monica, Calif., has framed the issue on her website:
The goal of breast cancer screening should be this: to find the cancers that have the potential to kill you, so that an intervention is necessary and can make a difference. We need to stop finding the cancers that will never do anything, and stop over-treating women who have them.
For this to occur, we need to do help women understand what mammography can and cannot do, and focus on finding the cause of breast cancer and preventing it altogether. I don’t want women going for mammograms they don’t need, or feeling a false sense of security because they have had one. I want them to have the opportunity to take part in the research that we need to go beyond a cure!
In addition to mammography screening for breast cancer, Neergaard discusses screening tests for prostate cancer in her AP article. She also gives some space to screening tests for for thyroid and cervical cancer. (Talk about unnecessary testing: Neergaard mentions a 2004 study that found an estimated 10 million women were still receiving Pap tests, which screen for cervical cancer, even though they’d had their cervix surgically removed — and for reasons that had nothing to do with cancer).
You can read Neergaard’s entire article here.