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CT Scan debate from bottom line health news letter!!


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The CT Scan Debate

Technology can be great, but it can also create new problems or challenges. Example: The debate over mammograms, which can improve early detection of breast cancer for some while increase anxiety for many others who fall victim to "false positives" that require further testing. Not surprisingly, a similar debate rages with computed tomography (CT) scans. These special X-rays are produced with an X-ray machine hooked up to a computer to generate cross-sectional images of the body, which can help detect tissue abnormalities, tumors and other conditions. Unfortunately, one concern that keeps popping up is the high rate of false positives (results that mistakenly identify disease when none is present), generating concerns about over-diagnosis and the high cost for additional testing.

To learn more about this problem, I contacted Stephen J. Swensen, MD, head of the Department of Radiology at the Mayo Clinic in Rochester, Minnesota. He was the lead researcher in a study last year on using CT scans to detect early-stage lung cancer. According to Dr. Swensen, CT scanning catches more early-stage lung cancers, but does not necessarily reduce death from the disease. So, is it worth it?


In the Mayo Clinic study involving 1,520 current or former smokers, an astounding 69% had false-positive findings, meaning that nodules originally identified as cancerous turned out to be benign. Among the possible consequences of these false positives are unnecessary and potentially risky biopsy procedures, unnecessary medical expenses and impaired quality of life. Moreover, the average death rate from lung cancer surgery is 3% to 5% -- this mortality rate would generally be acceptable in operations for a deadly condition, but not for a benign condition.

Even when growths are not benign, CT scanning detects more early-stage tumors that are sometimes so slow-growing that they are unlikely to cause a person to die from it in one's lifetime. This raises the question of whether or not detection by these methods is valuable for the population at risk. Dr. Swensen adds that other cancers are so lethal and fast-growing that there are not a lot of ways to effectively treat them, even when they are detected early.


I asked Dr. Swensen if this and similar studies mean that we should reconsider early CT screening for disease. Not yet, was his response, but he pointed out that large, multi-center trials should give us definitive answers in two to three years. As for now, he advises people at risk (for example, smokers) to undergo early screening for lung cancer only after being informed about the pros and cons of the procedure by a physician who is not an owner or part owner of the screening facility. Analyzing test results is not an exact science, and you want to be sure that the physician reviewing the results is focused solely on what is best for the patient.

Be well,

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