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How to avoid ‘incidentalomas’

If you’re like me, you’re hearing an increasing number of stories from people who have undergone a medical imaging test for one set of symptoms, only to have the scan reveal “something suspicious” that’s not related at all to the symptoms.
Only aft

The rise in CT scans has been linked to the rise in "incidentalomas."
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The rise in CT scans has been linked to the rise in “incidentalomas.”

If you’re like me, you’re hearing an increasing number of stories from people who have undergone a medical imaging test for one set of symptoms, only to have the scan reveal “something suspicious” that’s not related at all to the symptoms.

Only after many further tests (and days of worry) — and perhaps even a surgical procedure — is the medical diagnosis made: The suspicious finding is nothing, just a benign mass of some kind that will have no medical consequences at all.

In medical jargon, such findings are called “incidentalomas.” And they’re a fast-growing problem. As the American College of Radiology pointed out last fall in its new guidelines for physicians about how to deal with such findings, “although most incidental findings prove to be benign, their discovery often leads to a cascade of testing that is costly, provokes anxiety, exposes patients to radiation unnecessarily, and may even cause morbidity.”

In his most recent U.S. News & World Report “HealthCare Headaches” column, Dr. Kenneth Lin, a family physician and professor of family and preventive medicine at both Georgetown University and Johns Hopkins University, points out that a major factor in the rise in incidentalomas is our increasing use of computed tomography (CT) scans:

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A study published recently in the journal Radiology found that children visiting U.S. emergency rooms had five times as many CT scans in 2008 as in 1995. By 2008, 6 percent of pediatric ER visits involved a CT scan. The same research group, led by Dr. David Larson at Cincinnati Children’s Hospital Medical Center, previously found an even greater rise in scanning during adult ER visits, with 25 percent of patients age 65 and older, and 12 to 16 percent of younger adults, getting a CT scan in 2007.
In addition to increasing risks associated with radiation exposure, all of those CT scans turn up an awful lot of “incidentalomas,” the term that doctors use for incidental findings that could be (but probably aren’t) cancer. A study published last year in the journal Archives of Internal Medicine found that nearly 40 percent of CT and MRI scans performed for research purposes at the Mayo Clinic from January through March 2004 turned up at least 1 incidental finding. In the 35 patients in whom doctors took further action (additional testing, specialist consultation, or surgery), only 6 were judged by researchers to have clearly benefited from an investigation, while in the rest there was no clear benefit or clear harm, such as complications from surgery for a benign tumor. Of all types of scans, CT of the abdomen and pelvis … was the most likely to turn up an incidental finding.

Fortunately, there are things we can do (or more to the point, perhaps, not do), says Lin, to reduce our chances of being harmed by an incidentaloma:

Three experts in diagnostic medicine at the Dartmouth Institute for Health Policy and Clinical Practice recently recommended that patients who are told about an incidental finding always seek a second opinion to verify that the radiologist’s interpretation of their scan is correct, and understand that clinical observation of an incidentaloma is often a safer option than more testing or surgery. Also, they advise that patients adopt a “healthy skepticism” about testing and only consent to scans that are absolutely necessary to establish a diagnosis or plan of action, rather than ordered “just to be sure.”

Sometimes, doing nothing is the healthiest choice we can make.

You can read Lin’s column here.