The Dangers of CAT Scans

THE DANGERS OF CAT SCANS
MORE FACTS WHOSE IMPORTANCE CANNOT BE OVEREMPHASIZED

I wrote at some length on the dangers of unnecessary CAT Scans in the November issue.
Just published research results reinforce the very real dangers of cancer from computed tomographic (CT) Scans – CAT Scans for short.

The use of CAT Scans has risen 3x since 1993 to 70 million a year in 2007.  At an approximate cost of $1000 each this translates into 70 billion dollars, a truly mind-boggling figure!  The article authors predict that 29,000 future cancers could be related to those 70 million CAT scans.  They also calculate that 1.5% to 2.0% of all new cancers in this country are caused by CAT scans.

CAT Scans do “save lives”, but it is not clear how many.  I am not aware of any accurate research that supplies a clear estimate of benefit vs. harm. CAT scans are routinely overused in otherwise healthy people who simply do not need them.

MILLIONS OF UNNECESARY CAT SCANS
Some experts maintain at least one-third of all CAT Scans are unnecessary.   10,000 cancers a year — that’s an awful lot of unnecessary pain, suffering and death caused directly by our health care system.   Headaches, heart imaging (CT angiography used to evaluate coronary arteries) full body scans (so called “Oprah Scans”) used as screening studies in otherwise healthy individuals are common misuses of this powerful technology.

Indeed, full body scans are not recommended by the American Cancer Society, the FDA and the American Radiology Society.  Furthermore, CAT Scans commonly result in incidental findings that result in even more CAT Scans, blood tests, biopsies plus stress, worry and dollar cost.

The largest contributors to the problem are CAT scans of the abdomen and pelvis (14,000 cancers a year) chest (4100 cancers a year) and head (4000 cancers a year).

YOUNG PEOPLE AT GREATEST RISK
One third of all cancers are projected from CAT scans performed on people ages 35 to 54 years.  Of special concern are the 5 million CAT scans performed in kids under 18, who are 10 times more sensitive to the effects of radiation.  66% of all cancers are in females and the most common cancers are thyroid, breast and leukemias (blood cancers), tissues especially vulnerable to the effects of radiation.

A CULTURE OF FEAR
Given the current malpractice environment, many doctors are understandably terrified of missing a cancer or other serious condition, getting sued and losing their licenses.  Although doctors win most malpractice lawsuits, even those who win are often put through a long, grueling process that forces some of them out of practice.

States like Michigan and Massachusetts have measures in place that help limit frivolous law suits.  In Sweden, medical errors are usually attributed to the health care system, not the individual doctor, an approach not likely to find favor with malpractice lawyers in this country.  There’s no question that individual doctors who make egregious errors – amputating the wrong limb, for example – should be singled out, but the current arrangements foster a culture of false patient expectations and physician fear that is harmful to both.

PROTECT YOURSELF AND YOUR FAMILY
My advice to you is simple.  Always question any doctor who suggests a CAT Scan.  Ask him or her if they are aware of the information I have just given you.  The study noted below was just one of several well-designed studies that have appeared in first-tier peer reviewed mainstream medical journals.  Be especially suspicious if a CAT scan is ordered by a doctor with financial ties to the radiology service that will perform the service.  In fact, I recommend you fire any such doctor. Such self-interested referral practices are ethically questionable.  Finally, be sure to share this information with your family and friends.

Facts in this bulletin are derived from “Projected Cancer Risks From Computed Tomographic Scasn Performed in the United States in 2007”  de Gonazlaez et all, Archivse Internal Medicine, December 14/28, 2009.

Alan Inglis MD
American Country Doctor