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Bartelby
12-26-2011, 03:18 PM
"Published by the Institute of Medicine (IOM), the health arm of the National Academy of Sciences, the exhaustive analysis found that medical radiation, particularly the large radiation dose delivered by CT scans, is the foremost identifiable cause of breast cancer.

Almost 230,480 new cases of breast cancer will be diagnosed this year in the United States, and about 40,000 women will die of the disease, roughly one out of every 3,875 women.

The new Institute of Medicine report probably doesn’t sit well with the industry, hospitals and clinics that make so many millions of dollars selling and over-using CT machines. The authors suggest that women avoid “unnecessary” or “inappropriate” medical radiation, a thinly veiled criticism of the industry that will give you a CT scan for a tooth ache if you don’t object to it.

In 1980, there were 3 million CT scans performed in this country. The number rose to 62 million in 2006,[2] to about 70 million by 2007,[3] and, according to NBC, to 72 million this year.[4] It’s a growth industry that doesn’t care if it promotes tumor growth.

The IOM committee made several suggestions for preventive actions that women can take, and the very first one is to “avoid inappropriate medical radiation exposure.” In the “Question & Answer” section of the IOM analysis online, the authors recommend “Avoiding medical radiation and hormone therapy, unless they are medically necessary, is a good idea.”

This suggestion has a vexing corollary since so-called mammography is just a lower dose of X-radiation given directly to breast tissue. Yet the new IOM study’s authors say in a footnote, “While recognizing the risks of ionizing radiation exposure, particularly for certain higher-dose methods (such as CT scans), it is not the committee’s intent to dissuade women from routine mammography screening.” Yet the advisability of mammography has been under attack ever since the British medical journal The Lancet in Oct. 2006 reported on a study by Dr. Peter Gotzsche that found the produced no health benefits. The late Dr. John Gofman argued for his entire career that X-rays caused more breast cancer then they detect, a position defended at length by Dr. Samuel Epstein in his book “The Politics of Cancer.”

CT Scans may cause 29,000 cancers and 15,000 cancer deaths every year."

El Diablo
12-27-2011, 04:54 AM
The data on mammography has never been very impressive, especially in women under 50, where it's not very useful for finding tumors because the surrounding breast tissue is still fairly dense. Studies of utility of diagnostic procedures are sometimes confounded by other concurrent advances. This was well demonstrated years ago when it was felt that Pap smears had lowered the mortality from cervical cancer, yet it was found the rate had gone down equally in countries where the smears weren't being done. Having said that, it should be noted that the post here is sprinkled with many qualifying statements, as the IOM understands that CT scans save lives by facilitating diagnoses that could only be made 40 years ago with exloratory surgery, which carries its own mortality rate, and by allowing diagnosis in places where exploratory surgery was not possible, as in parts of the brain. IOM is prudent to say CT should be done when medically indicated; what that means is not always certain.

El Diablo
12-27-2011, 04:58 AM
(The OP also neglects to mention that it's not the medical establishment that favors CT scans, but the insurance industry. CT is much cheaper than MRI and PET scans, which seem to carry less risk and which in most but not all cases can be used instead of CT, but the insurance industry puts up barriers to using the more expensive tests, forcing doctors and hospitals to do CT)

VaththalKuzhambu
12-27-2011, 08:40 AM
(The OP also neglects to mention that it's not the medical establishment that favors CT scans, but the insurance industry. CT is much cheaper than MRI and PET scans, which seem to carry less risk and which in most but not all cases can be used instead of CT, but the insurance industry puts up barriers to using the more expensive tests, forcing doctors and hospitals to do CT)


Not true. A large proportion of the harm from CT is related to screening tests rather than diagnostic tests. United State Preventive Services Task Force (USPTF) recommendations on reducing the frequency of screening exams for breast cancer and prostate cancer did not go well with the medical establishment.

ollinger
12-27-2011, 08:51 AM
1) a screening test IS a diagnostic test.
2) studies such as the National Lung Screening Test collaborative study showed that screening smokers with CT reduced the death rate, and reduced it more than was accomplished with screening chest X-rays.
3) the "medical establishment" is very wary when the biggest growth industry in medical malpractice is suits for "failure to make early diagnosis." I saw a patient in my office last week who contacted an attorney because it took her husband's pulmonologist TWO MONTHS to order a lung CT. I'm not one who thinks tort reform is the answer to health care costs, but I guarantee you the number of screening tests and other surveillance tests would drop dramatically if physicians were protected from nonsense like this. Much of the public seems to believe that a condition diagnosed today rather than yesterday is grounds for a grievance.

Cindysphinx
12-27-2011, 12:28 PM
Why should it take two months to order a lung CT?

ollinger
12-27-2011, 01:02 PM
^^ it took two months for the patient to disclose the extent of his smoking history. But you miss the point; two months is a fairly negligible period of time in dealing with something like screening for a lung mass, but patients have expectations inconsistent with what is considered reasonable intervals for screening. Patients (and plaintiffs attorneys) often insist on screening -- and exposure to radiation -- more often than is medically needed. (The attorney wins either way, suing somebody if the radiation is considered a factor in subsequent disease).

VaththalKuzhambu
12-27-2011, 01:04 PM
1. A screening test IS WAY DIFFERENT from a diagnostic test. http://www.dslrf.org/breastcancer/content.asp?CATID=31&L2=1&L3=6&L4=0&PID=&sid=132&cid=655

2. "reduced the death rate" is an ambiguous term and, nevertheless, should not be the sole criteria. The NLST manuscript in New England Journal of Medicine states "The rate of positive screening tests was 24.2% with low-dose CT and 6.9% with radiography over all three rounds. A total of 96.4% of the positive screening results in the low-dose CT group and 94.5% in the radiography group were false positive results." http://www.nejm.org/doi/full/10.1056/NEJMoa1102873

3. While I am somewhat tolerant towards a conservative approach involving regular screenings, under fear of malpractice lawsuits, I cannot digest the medical establishment promoting frequent screenings under the guise of threat to life. This is akin to the public safety officials (police, fire, emt) promoting the need for unions and collective bargaining, under the guise of reduced resources and slower response times in an emergency.

p.s.: I was part of the NLST team, in the analytical wing.

VaththalKuzhambu
12-27-2011, 01:12 PM
Folks contributing in the comments section to the NLST article on the NEJM website have articulated the matter well: http://www.nejm.org/doi/full/10.1056/NEJMoa1102873#t=comments

sapient007
12-28-2011, 07:08 AM
ionization ration causes cancer. no big surprise here. don't get too many CT scans a year makes a lot of sense. doesn't take a rocket scientist to figure out that the national limit on radiation is 5REM and that's why most folks in radiography are monitored closely to ensure that the limit is not exceeded. i wasn't able to find the IOM document for direct reference but this page seems to point out several other factors listed higher then the CT scan

http://www.iom.edu/Reports/2011/Breast-Cancer-and-the-Environment-A-Life-Course-Approach.aspx


IMO..if it's your 1st CT scan in many years to check for breast cancer, you should prob take it. however if you go zapped like 20 times already last month, take it easy.. go a see a doctor first.

Cindysphinx
12-28-2011, 09:27 AM
^^ it took two months for the patient to disclose the extent of his smoking history.


Huh?

If someone says they are a smoker, they are a smoker. I don't understand what difference it would make if the smoker fudged a little ("Oh, I've smoked off and on my whole life, but not much") because we all know that's a lie.

But you miss the point; two months is a fairly negligible period of time in dealing with something like screening for a lung mass, but patients have expectations inconsistent with what is considered reasonable intervals for screening. Patients (and plaintiffs attorneys) often insist on screening -- and exposure to radiation -- more often than is medically needed. (The attorney wins either way, suing somebody if the radiation is considered a factor in subsequent disease).

Again, I don't understand.

If I had a suspected lung mass and I called to get the next appointment to have it checked out and I was told I had to wait two months, I would consider this unacceptable and would schedule with a different facility. I can see why a patient might be irritated if they visited a doctor and, for whatever reason, the doctor didn't order a test for two months. We can argue about whose fault this was (the patient's intake forms should be pretty clear about whether the patient fibbed), but I wouldn't consider two months to be insignificant.

I agree that patients often want screening more often than is medically necessary. If a woman with no history of breast cancer (like me) wanted a mammogram every six months instead of every year, I agree with you that this would be unjustified.

I think that, from a patient's perspective, doctors can be a little cavalier about what is medically necessary. This is understandable, of course. Doctors see the big picture. The patient is concerned about exactly one patient: Herself.

Bhagi Katbamna
12-28-2011, 09:38 AM
It seems that the rate of breast cancer in the US is increasing and being found in younger women.

chrischris
12-28-2011, 09:42 AM
"Published by the Institute of Medicine (IOM), the health arm of the National Academy of Sciences, the exhaustive analysis found that medical radiation, particularly the large radiation dose delivered by CT scans, is the foremost identifiable cause of breast cancer.

Almost 230,480 new cases of breast cancer will be diagnosed this year in the United States, and about 40,000 women will die of the disease, roughly one out of every 3,875 women.

The new Institute of Medicine report probably doesn’t sit well with the industry, hospitals and clinics that make so many millions of dollars selling and over-using CT machines. The authors suggest that women avoid “unnecessary” or “inappropriate” medical radiation, a thinly veiled criticism of the industry that will give you a CT scan for a tooth ache if you don’t object to it.

In 1980, there were 3 million CT scans performed in this country. The number rose to 62 million in 2006,[2] to about 70 million by 2007,[3] and, according to NBC, to 72 million this year.[4] It’s a growth industry that doesn’t care if it promotes tumor growth.

The IOM committee made several suggestions for preventive actions that women can take, and the very first one is to “avoid inappropriate medical radiation exposure.” In the “Question & Answer” section of the IOM analysis online, the authors recommend “Avoiding medical radiation and hormone therapy, unless they are medically necessary, is a good idea.”

This suggestion has a vexing corollary since so-called mammography is just a lower dose of X-radiation given directly to breast tissue. Yet the new IOM study’s authors say in a footnote, “While recognizing the risks of ionizing radiation exposure, particularly for certain higher-dose methods (such as CT scans), it is not the committee’s intent to dissuade women from routine mammography screening.” Yet the advisability of mammography has been under attack ever since the British medical journal The Lancet in Oct. 2006 reported on a study by Dr. Peter Gotzsche that found the produced no health benefits. The late Dr. John Gofman argued for his entire career that X-rays caused more breast cancer then they detect, a position defended at length by Dr. Samuel Epstein in his book “The Politics of Cancer.”

CT Scans may cause 29,000 cancers and 15,000 cancer deaths every year."


Hello...

Bartleby, in your view whats the main underlying reason people get cancer outside of the scans being a possible factore here ?

ollinger
12-28-2011, 10:17 AM
Uh, no Cindy, "if someone says they are a smoker, they are a smoker" oversimplifies the issue. If someone smokes a few cigarettes a week, should you expose an asymptomatic person with a normal chest X-ray to the added radiation of a CT scan to look for a lung mass? There is NOT a clear or simple answer to that question, and the consensus has been "no". If they later say they smoke much more than that, the issue is now different.

sapient007
12-28-2011, 10:45 AM
It seems that the rate of breast cancer in the US is increasing and being found in younger women.

have seen reports on the "avg" american fast food diet?

ollinger
12-28-2011, 12:34 PM
^^^ the issue of fat intake and breast cancer has been the subject of a number of studies in US, Scandinavia and elsewhere, a few suggesting a relationship but most showing no clear relationship.

r2473
12-28-2011, 12:58 PM
Makes a lot more sense to just lop the girls off and get fake ones. Perfect breasts, no more cancer. What's not to love?

I'm getting a booty implant next month.