Is That CT Scan Really Necessary? Benefits vs Risks

Can you imagine a 100 year old woman experiencing her first mammogram? Or a healthy 80-year-old man who was left incontinent and impotent by radiation treatments for prostate cancer, a disease that typically grows so slowly that many men die with, but not of it. Every year, like clockwork, there are thousands of women in their eighties, who still get their annual mammogram and undergo screening colonoscopies at three- or five-year intervals whether or not they have had cancerous polyps that would warrant such frequent testing.  Every year there are thousands of men in their eighties who faithfully get regular PSA tests to check for prostate cancer and routine cholesterol screenings, which can lead to the prescription of statin drugs that require regular blood tests to check liver function.  (Typically, cholesterol plaque takes years to accumulate, and statins confer only a modest benefit in the elderly.)

The New England Journal of Medicine reported in March, 2010, that too many angiograms were administered to patients who do not really need them. Angiograms which are invasive imaging tests for heart disease carry a slight risk for stroke or heart attack during the procedure. (www.kaiserhealthnews.org/daily

The Journal   also reported in an article in September, 2010, Lessons from the Mammography Wars, © 2010 Massachusetts Medical Society, that there is a disagreement among physicians regarding the age at which to begin, and end as well as how often administer mammograms.  It had been assumed that for all women over the age of 40, breast cancer screening with mammography should be a once a year routine. The discussion continues to this day.. www.nejm.org/lessonsfromthemammographywars.)

One has to wonder about these routine screenings for cancer and other ailments for people in their 70s, 80s and 90s, even at 100!. Many medical experts say there is little evidence of benefit, and considerable risk, from common tests for colon, breast and prostate cancer, because these tests often trigger a cascade of expensive, anxiety-producing diagnostic procedures and invasive treatments leaving patients worse off.

What is the cause of perpetual over-testing that has little benefit to the health of patients and increases the cost of healthcare by an order of magnitude for all of us? Are these tests ordered by doctors who are trying to be cautious and avoid malpractice lawsuits? Or are they demanded by patients who are becoming more educated about what is available, and fueled by an attitude among US patients that,if a screening is available, it should be done whether or not it is needed?  A 2010 study in the Journal of the American Medical Association of more than 87,000 Medicare patients found that a "sizeable proportion" with advanced cancers continued to be screened for other malignancies. We have to ask whether this is good medical practice.

The New York Times reported in June 2011, that long after research indicated that CT Scans can expose people to dangerous radiation levels if done too frequently, Medicare was making payment for scores of elderly patients in hospitals throughout the country who were given two scans in succession on the same day – one using contrast to check blood flow and one that did not. This practice has been stopped, but many forms of over testing still occur every day. www.nytimes.com/health/guides/test/abdominal-ctscan/overview.html

.Why do doctors continue to screen elderly, ill patients?  What can patients do about it?
he Foundation for Informed Medical Decision Making offers some guidelines for e-patients who want to control their own destiny, avoid unnecessary, often painful tests, and be mindful of the cost of their care as follows:

1.  For all tests, ask two questions. What is this test for? And, what do you expect to find?

2.    For tests the doctor runs in the office (blood work, EKGs, MRIs), ask the questions above, and then ask what that test will answer that another test, already ordered, may not. Or, ask if there is a less expensive test, available that will supply enough information but not more than is needed.
3.    For all tests, ask when the results will be available, and ask that copies of tthe test results and records be supplied to you directly as well as to your doctor.
4.    Finally, ask the doctor about scheduling a time, whether by phone, email, an e-visit or in person, to discuss test results and treatment options before you agree to further tests and procedures.
Only you can assure that for every test or procedure you undergo, the benefit outweighs the risk.