Radiation risk or timely diagnosis: What would parents choose?

It is so nice to be right.

To summarize what I wrote almost 4 years ago, based on my experience, patients and families will accept the theoretical risk of a future cancer if it means they’ll get an accurate diagnosis.

A recent study validates that opinion.

MedPage Today reports that before receiving any recommendation for CT scanning, 742 parents of children who presented with head injuries were surveyed by researchers from Toronto’s Hospital for Sick Children.

Parents, almost half of whom had previously known that CT scanning might cause a cancer to develop in the future, were told of the radiation risks of CT scanning in detail. The authors found that although the parents’ willingness to go ahead with the CT scan fell from 90% before the explanation of risk to 70% after they were briefed about radiation, at crunch time only 42 (6%) of them refused to let their child be scanned.

And of the 42 who initially refused, 8 eventually went ahead with the scan after a physician recommended it.

So to put it another way, even after they were fully informed of the potential risk of CT scan radiation to their child (lifetime risk of cancer is about 1 in 10,000, according to the authors), nearly all parents opted for the scan.

Also of note are the following:

  • the median age of the children was 4
  • 12% of the children in the study had undergone at least one previous CT scan
  • 97% of the children were diagnosed with only concussions or mild head injuries

An article in Scientific American puts some of the radiation risk into perspective. It is long, but worth reading as it explains how risk has been calculated, the best guess as to the true level of risk, and what radiologists are doing to lower the radiation exposure associated with CT scanning.

According to that article, “Any one person in the U.S. has a 20 percent chance of dying from cancer [of any type]. Therefore, a single CT scan increases the average patient’s risk of developing a fatal tumor from 20 to 20.05 percent.”

No one ever comments about weighing the potential harms that may have been prevented by a timely CT scan diagnosis against the radiation risk.

CT scans should be ordered judiciously. The area scanned and the amount of radiation should be limited as much as possible.

But if you need a CT scan to help diagnose your problem, go ahead and have it.

Bottom line: When it comes to accuracy in diagnosis versus radiation-induced cancer risk, parents overwhelmingly chose the former.

“Skeptical Scalpel” is a surgeon blogs at his self-titled site, Skeptical Scalpel.

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  • Patient Kit

    A somewhat related question: Are “preventative” whole-body CTs still being marketed to the worried well (with no need for an Rx/referral from a doctor)? That hot trend seemed insane to me. And irresponsible. I hope it was just a short-lived fad.

    Personally, I’ve had a handful of CTs in my life, both around legitimate suspicions of cancer (one of which turned out to actually be ovarian cancer). The other time was 12 years ago when my femur unexpectedly fractured while I was just walking down the street (no trauma involved). That fracture was caused by a lesion that was suspected of being cancer so, my docs scanned all of me since cancer in my bone most likely would have metastasized from elsewhere. Thankfully, that one was not malignant. But even now, a year and a half after my OVCA dx and surgery, my GYN ONC uses CTs sparingly.

    Some people think regular whole-body CTs are a good idea. Some people would like general anesthesia when they have their teeth cleaned. Some people really don’t do the risk/benefit analysis thing well.

  • Lisa

    PK said in her comment below that “some people really don’t do the risk/benefit analysis thing well.” One of my pet peeves is that doctors often don’t do a good job of discussing the risk and benefits of a given treatment or procedure. They often use absolute figures when describing benefits rather than relative figures, making the benefit sound much greater. Same thing with risk.

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