Kudos for the WSJ for publicizing risks of cardiac CT testing. Not enough emphasis is placed on the potential risks of the latest and greatest diagnostic tests:
The authors concluded that the lifetime risk of cancer attributable to 64-slice scans, used to diagnose heart disease, varies widely. It’s highest for women, younger patients, and for scans that look at the aorta and coronary arteries. The risk for cancer attributable to the scans ranges from less than 0.02% for 80-year-old men receiving a type of scan modified to minimize radiation dose to 0.88% for 20-year-old women undergoing a scan of the heart and aortic arch. Overall, lungs are at most risk. For young women, the risk is greatest for breast cancer.
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I share your kudos to wsj for publishing this study and agree that not enough emphasis is placed on risks related to diagnostic tests. Unfortunately the first response to the article was one, saying in less kind terms, that it is not important to share this information with the public.
How can our patients work with us and make educated informed choices if they are unaware of risks as well as benefits?
For example, many people have come to expect a chest x-ray if they present to their doctor with a cough. It was recently shown that girls who carry a certain genetic predisposition to breast cancer are more than four times more likely to develop breast cancer in the future if they have chest x-rays before the age of 20 (Andrieu, 2006). Since most 10 year olds have not had genetic testing for breast cancer, we need to make sure those x-rays performed are truly necessary. I am sure a parent, being aware of a small but potential risk, would be more comfortable accepting the results of a careful clinical exam and close follow-up in liu of an initial x-ray than one who is not.
In med school we were told that the majority of conditions could be diagnosed with a careful history and physical exam. I don’t think that has changed.
Lynne Eldridge MD
Author, “Avoiding Cancer One Day At A Time”
http://www.avoidcancernow.com
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