CT scans as a cause of cancer

Patients have a part to play as well. Consumers can go to the Choosing Wisely [www.choosingwisely.org] website to learn about the most commonly overused tests.

Before agreeing to a CT scan, they should ask:

■ Will it lead to a better treatment and outcome?

■ Would they get that therapy without the test?

■ Are there alternatives that don’t involve radiation, like ultrasound or MRI?

■ When a CT scan is necessary, how can radiation exposure be minimized?

Neither doctors nor patients want to return to the days before CT scans.

But we need to find ways to use them without killing people in the process.

Are we giving ourselves cancer with CT scans? PENINSULA POLL BACKGROUNDER: By Rita F. Redberg and Rebecca Smith-Bindman 14 June 14, DESPITE great strides in prevention and treatment, cancer rates remain stubbornly high and may soon surpass heart disease as the leading cause of death in the United States.

Increasingly, we and many other experts believe that an important culprit may be our own medical practices: We are silently irradiating ourselves to death.

The use of medical imaging with high-dose radiation — CT scans in particular — has soared in the past 20 years.

Our resulting exposure to medical radiation has increased more than sixfold between the 1980s and 2006, according to the National Council on Radiation Protection & Measurements.

The radiation doses of CT scans (a series of X-ray images from multiple angles) are 100 to 1,000 times higher than conventional X-rays.

Of course, early diagnosis thanks to medical imaging can be lifesaving. But there is distressingly little evidence of better health outcomes associated with the current high rate of scans.

There is, however, evidence of its harms.
The relationship between radiation and the development of cancer is well-understood:

A single CT scan exposes a patient to the amount of radiation that epidemiologic evidence shows can be cancer-causing. The risks have been demonstrated directly in two large clinical studies in Britain and Australia.

In the British study, children exposed to multiple CT scans were found to be three times more likely to develop leukemia and brain cancer.

In a 2011 report sponsored by Susan G. Komen, the Institute of Medicine concluded that radiation from medical imaging, and hormone therapy, the use of which has substantially declined in the past decade, were the leading environmental causes of breast cancer and advised that women reduce their exposure to unnecessary CT scans.

CTs, once rare, are now routine.

One in 10 Americans undergo a CT scan every year, and many of them get more than one. This growth is a result of multiple factors, including a desire for early diagnoses, higher-quality imaging technology, direct-to-consumer advertising and the financial interests of doctors and imaging centers.

CT scanners cost millions of dollars; having made that investment, purchasers are strongly incentivized to use them.

While it is difficult to know how many cancers will result from medical imaging, a 2009 study from the National Cancer Institute estimates that CT scans conducted in 2007 will cause a projected 29,000 excess cancer cases and 14,500 excess deaths over the lifetime of those exposed.

Given the many scans performed over the past several years, a reasonable estimate of excess lifetime cancers would be in the hundreds of thousands.

According to our calculations, unless we change our current practices, 3 percent to 5 percent of all future cancers may result from exposure to medical imaging.

We know that these tests are overused. But even when they are appropriately used, they are not always done in the safest ways possible. ………

The American College of Radiology and the American College of Cardiology have issued “appropriateness criteria” to help doctors consider the risks and benefits before ordering a test.

And the insurance industry has started using radiology benefit managers, who investigate whether an imaging test is necessary before authorizing payment for it. ……..

Patients have a part to play as well. Consumers can go to the Choosing Wisely [www.choosingwisely.org] website to learn about the most commonly overused tests.

Before agreeing to a CT scan, they should ask:

■ Will it lead to a better treatment and outcome?

■ Would they get that therapy without the test?

■ Are there alternatives that don’t involve radiation, like ultrasound or MRI?

■ When a CT scan is necessary, how can radiation exposure be minimized?

Neither doctors nor patients want to return to the days before CT scans.

But we need to find ways to use them without killing people in the process.
______

Rita F. Redberg is a cardiologist at the University of California, San Francisco Medical Center, where Rebecca Smith-Bindman is a radiologist. Their essay first appeared in The New York Times. http://www.peninsuladailynews.com/article/20140615/news/306159974/peninsula-poll-backgrounder-are-we-giving-ourselves-cancer-with-ct

June 16, 2014 - Posted by Christina Macpherson | radiation, USA

1 Comment »

This old news. For many years it had been known to medical science that low dose medical x rays cause cancer, especially breast cancer (see “The Mammogram Myth” by Rolf Hefti). The problem is that the big business of orthodox medicine and the nuclear industry have been dismissing and ignoring these facts. This wicked game is ongoing to protect corporate interests.

Comment by Lars | June 17, 2014 | Reply