Academic journal article The Hastings Center Report

Carcinogenic Diagnosis

Academic journal article The Hastings Center Report

Carcinogenic Diagnosis

Article excerpt

If a diagnostic procedure increases cancer risk, should patients be informed of that risk? Apparently not, at least for one procedure performed more than 150,000 times a day in the United States. (1) CT scans use multiple x-rays to create three-dimensional images that are diagnostically useful but expose people to far more radiation than conventional x-rays. In fact, one CT scan exposes a patient to the lower range of radiation received by some Nagasaki bombing survivors. Up to one in a thousand patients will develop cancer from this exposure. (2) Sixty million CT scans a year will thus cause cancer in thousands of people. Yet most consent forms are silent about this.

The cancer-causing effects of CT scans are routinely discussed in the medical literature, and some researchers have worried about the long-term effects, especially in children, who have more dividing cells to disrupt and more time to develop cancer. Others trivialize the risk, arguing that the benefits are worth it. Yet patients undergoing CT scans are informed of the much rarer risks of serious complications and deaths (one in 400,000) caused by injection of iodinated contrast material. Serious allergic reactions are dramatic and almost immediate, but most people will survive even severe allergic reactions, especially when they take place in a health care facility. Cancers may take decades to manifest, but can be devastating. And that an effect is delayed is hardly justification for not mentioning it; informed consent for cancer treatment includes discussion of the long-term risks of inducing new cancers.

Some researchers have also suggested that since the background risk of getting a fatal cancer is one in five, what's the harm in a little topping off?. Iatrogenic risks are different from the background risks of daily living, however. Besides, the concern is not just that the incidence of cancer will be increased, but that it will occur earlier. One of five people eventually may die of cancer but dying of cancer at age fifty instead of ninety surely makes a difference.

The literature notwithstanding, the silence on medical radiation risks is not due to a conspiracy of doctors: they are largely unaware of the problem. One survey found that less than half of radiologists, and less than a tenth of emergency room doctors, realized that CT scans increased the lifetime risk of cancer. …

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