Every couple of years or so I go to a hospital and have a long needle inserted into my neck. It's no fun and so far the results of these thyroid biopsies have been that the nodules in my thyroid do not show a galloping thyroid cancer. There are risks to this screening (an elementary biology lesson tells me that there are important blood vessels around the thyroid: What if they were nicked by mistake?) But I weigh the so-called risks against the benefits and continue to go when my endocrinologist sends me.
Most of us today get screened for something or other, be it cholesterol, breast cancer or hypertension. After a certain age the colonoscopy beckons, women over 40 are reminded that mammograms find cancer better than breast self-examination, and men with a high PSA may encounter further intervention in the form of a prostate biopsy. A pain here, a stiff neck there, a bum knee, a headache that won't go away: The use of CT scans, MRIs and other imaging tests has nearly tripled since 1996. It's not only that some of these screenings result in overdiagnosis but also that our exposure to potentially harmful ionizing radiation has also increased.
A report last week revealed that doctors rarely discuss with patients the risk of cancer screening. In a small study at the Max Planck Institute for Human Development in Berlin, fewer than one in ten adults who were invited by their doctors to undergo cancer screening said that their doctor had brought up the chance of overdiagnosis and overtreatment when talking about screening.
During my various visits for screening (mammography, CT scans, etc.) I have seen posters, pamphlets, cautioning me to review the risks of said test. But the facts are this: You are sent for a CT scan and it literally is a no-brainer and it can take less time than it takes to make a latte. I don't know about you, but I never think about the radiation that my body is receiving. I am thinking about trying to remember where I parked my car and hoping that this machine does not find anything in my body that shouldn't be there.
"Inappropriate imaging carries many potential risks," wrote Dr. James Fraser and Dr. Martin Reed in an article published last spring in the Canadian Association of Radiologists Journal (www.carjonline.org) "In recent years, patient safety related to radiation exposure has gained much publicity with recent evidence of definable mortality risk being ascribed to individual CT studies."
The radiologists add that another potential harm is in something they call "incidentaloma". Any examination can lead to incidental findings, the vast majority of which are benign but often require further investigation. This potentially exposes patients to further radiation, anxiety, and even invasive procedures, all for little or no benefit."
A friend of mine who had a chest x-ray was further directed by her doctor to have a CT scan because the x-ray showed something, though her doctor was not particularly concerned. The CT scan showed something suspicious so her doctor then suggested a biopsy. The whole process, from the get-go, made her understandably anxious, she told the doctor who eventually did a lung biopsy on her. That doctor, British-trained, told her that she was probably just another victim. "In Britain, we refer to it as VOMIT," he said. "Victims of Medical Imaging Technologies."
VOMIT is an acronym for our medical times, and doctors who love acronyms will tell you that BARF (the Brainless Application of Radiological Findings) is almost as common. In response to last week's study that suggested that doctors may not be conveying to patients the risk of overdiagnosis or overtreatment when recommending routine cancer screening, Chris Kaiser of www.medpagetoday.com asked doctors what they thought.
One mentioned that patients worried about cancer "may indeed not remember details" about risks because their focus is on getting the test and finding out if they have cancer. Another doctor made the point that risk/benefit analysis is a complicated concept -- one that many doctors, never mind their patients, fail to entirely grasp. Still another pointed out that in the U.S. at least the top reason for a lawsuit against primary care physicians is failure to diagnose cancer.
With patients piled up in their waiting rooms, I doubt that many doctors today have time to convey the complexities of screening risks. It therefore falls back on us, as consumers of health screening tools, to press our doctors for information and to do a little homework. A website such as www.cancer.net with its oncologist-approved information goes a long way in covering various screening benefits and risks. At www.imagewisely.org, there's an extensive examination of radiation risks, including a chart of perceived risks (x-rays were seen to be a lot less risky that cars, smoking, alcohol, handguns and surgery.) Don't forget that radiation is all around us and includes air travel.
So to screen or not? Years ago, a mammogram I had revealed "something" so I was sent for a breast biopsy. Risks and benefits were well communicated to me, but when the radiologist was ready to begin the procedure he noted that he couldn't find the "something" that the original mammography found. We never went ahead with the biopsy and, a several mammograms and years later, the "something" never reappeared.
I was a victim, I guess, a VOMIT. As for my friend whose doctors initially thought her "something" was probably nothing dangerous, the eventual biopsy revealed a tiny lung cancer. She was treated and is now absolutely fine. So for those of us who worry that the somethings found on routine screenings are not just nothings, confirming that we're only VOMIT may not be so bad at all.