An opinion piece written by two University of California-San Francisco physicians a cardiologist and a radiologist goes to extreme lengths to warn us about the ongoing cancer epidemic due to the massive overuse of semi-automatic (pun intended) CT scans.
There s just one problem: there is no cancer epidemic, and the piece is replete with misleading scare statistics and exaggerations based on minimal or no evidence.
Sure, CT scans are over-used. Today s technologically brilliant but clinically challenged generation of doctors are used to getting all sorts of lab tests, including blood, urine, XRays, angiograms, Dopplers, ECGs and ultrasounds, before deigning to actually talk to (much less examine) patients. And often, especially in the busy environs of the ER, stressed-out docs just do not have the time or bed-space to thoroughly investigate the indications for radiological procedure before the reflexive, Get the CT and give me the report, then I ll call the (insert name of sub-specialty here).
But to read this sky is falling op-ed by Drs. Redberg and Smith-Bindman, one would think that every CT scan is pointing a dagger at your heart, or spleen, or wherever your particular favorite cancer-phobia site is. The tipoff to the writers agenda is easily discerned from the first few lines, when they warn that cancer rates remain stubbornly high and may soon surpass heart disease as the #1 killer in the U.S. Really? But cancer rates incidence and mortality are going down, as CT scan usage continues to rise. That s inconvenient for these authors agenda, so never mind. And anyway, what disease or condition would they prefer to become the #1 killer cause something s got to be it. They know, I am certain, that cancer is going to be the leading cause of death not because of that apocryphal cancer epidemic, but because cancer is many different diseases which have a tendency to increase with age, and so is our population, while heart mortality is plummeting.
They refer to an excellent IOM report from 2011 which identified environmental causes of breast cancer. True, ionizing radiation was felt to be the leading such cause, but it was not found to be a major, or even significant, causal factor (and that report basically absolved all those environmental chemicals so beloved...I mean hated, by some Breast Cancer Organizations). They too warned against unnecessary exposures to radiation, mainly from radiological procedures. Today s authors assert, We know that these tests are overused ¦., and they advise patients to ask, before agreeing to a CT scan, Will it lead to a better treatment or outcome?
As ostensibly practicing clinicians, you would think the authors would know better than to put such questions in the mouths of unsophisticated people; and even more farfetched, to expect ethical professionals to respond productively. Only God, Asklepios-Cadeucius, and the plaintiffs attorneys omnipresent, haunting hospitals and TV ads, can possibly know with any degree of reasonable certainty whether a test of any type will lead to better outcomes. The 20/20 retrospectroscope knows all and tells all but too late.
ACSH s Dr. Ross added this: They go so far off the deep end as to suggest that the FDA should take over supervision of when to do a CT scan! Yeah, they've been so great at overseeing the drug supply and advising smokers how NOT to give up smoking. Now is the worst possible time to scare people about CT scans. Recent data and the official federal panel recommendations implore smokers and ex-smokers to get an annual spiral CT scan to detect life-threatening lung cancers and save lives thereby. The last thing we need is to have a smoker ask his or her doctor, Do I really need that scan?' No, of course not IF you don t have an early lung cancer. I wonder how the authors would answer.