Letting CT Scans Out of the Bag

Just when you realized it was safe to drink the water after the recent arsenic scare, FDA officials are taking their turn to cry, “Wolf!” They struck last week in a front-page Los Angeles Times article about their worries over radiation dangers from screening whole body CT scans.

Scared people are literally stopping us in the street with questions. Judy Slutsky of Newport Beach, Calif., told us, “When I read the article I cancelled my scan appointment.” As retired radiologists, we’re concerned about patients’ unfounded fears.

In medicine, “screening” means looking for a medical condition in a person showing no symptoms in the hope of identifying problems early, when treatment can be most effective. For example, most mammograms are done on women who do not have a lump in the breast or other evidence of breast cancer. The PAP test for cervical cancer is another well-known and productive screening test. CT scans can detect small calcium deposits in arteries, a sign of hardening of the arteries that can lead to heart attacks or strokes.

These screening CT scans are almost always paid for directly by the patient. Commercial and government insurance does not usually pay for these scans.

A single CT scan examination can show fine details in a wide range of tissues, such as the lungs, kidneys and bones. CT scans can detect very small cancers in the lungs, before the cancer is visible on a standard chest x-ray or detectable by other tests.

The one-sided statements reported in the Los Angeles Times article are not the reporter’s fault. We’ve all seen hundreds of scare stories about radiation from x-rays and nuclear power plants. The beneficial effects of low doses of this radiation are not nearly as newsworthy as the very rare accidental injury or death from these invisible rays. Also, the public has been effectively shielded from facts because of suppression of scientific advances by vested interests in the “radiation phobia” business.

For example, you’ve probably never heard of the Nuclear Shipyard Workers Study conducted by researchers at Johns Hopkins University; the health of workers exposed to low doses of radiation from working on nuclear-powered ships was compared with the health of workers doing similar work on non-nuclear ships. The preliminary 1991 report of the study found that workers receiving low radiation doses had significantly lower death rates and were generally healthier than workers not getting a small extra dose of radiation. Despite millions of taxpayers’ dollars paying for the research, this good news has not yet been released in a formal scientific article. Some scientists are worried that the data is bottled up in researchers’ vaults because it might raise questions about the current radiation protection business and threaten careers based on outdated radiation protection paradigms.

The current scare is based on the May 17 report of Thomas B. Shope Jr., Ph.D., an FDA official, to the FDA Technical Electronic Product Radiation Safety Standards Committee. Shope has a vision of “safety” lacking a balancing vision of possible benefits.

At the meeting, Dr. John F. Cardella, of the State University of New York, Syracuse Health Science Center, and a member of this advisory committee expressed concern about the lack of “oversight” and “checks and balances” in screening CT. Marlene Cimons, the author of the Los Angeles Times article mentioned above, quotes Dr. Cardella as saying “For an average Joe to walk in off the street and get himself screened from head to toe is probably a bad idea, especially if he isn’t in any risk group.”

Currently, the FDA has no mandate from Congress to decide how CT scans are to be used by doctors. We suspect FDA “mission creep” in that the comments of some of the staff and committee members imply a desire for greater FDA regulatory power. Of course, safety is the stated goal but the complications of this search for safety are likely to do more harm than good, judging from other recent government interventions and misadventures in medicine. In the present case, the concerns and risks discussed at the meeting were not balanced by discussion about benefits.

Compared with the damage from fears generated by such FDA officials, CT scan x-rays are innocuous and innocent. From the statements made at the meeting, FDA officials and members of the advisory committee seem to be unaware of some of the recent good news about radiation from modern science. Some of this good news includes:

– A single unit or photon of x-ray or other radiation won’t hurt you or cause a body cell to become a cancer, just as a single aspirin tablet won’t poison you.

– Low radiation doses enhance health, as do low doses of vitamins, aspirin, and many minerals. Radiation doses under 0.25 Seivert per year (about 25 rad or 25 rem in other radiation units) are well inside this range. This is twice the level of most screening CT examinations. At the very least, scientific evidence shows that radiation doses at this level are safe.

– The radiation dose from a whole-body CT scan is safe.

– When radiation doses are spread out over time, the body tolerates even more radiation without harm, as it does with other agents, such as aspirin. As we are both over 60 years old, we each take one quarter of an aspirin tablet every day to decrease our risk for heart attack and stroke; we take 2 tablets when we have a headache. But if we took 100 tablets at a time, we’d die of aspirin poisoning. We’re sure we’ve taken several hundred aspirins over our lifetime and we’re not dead yet!

– Advances in science have disproved the linear no-threshold (LNT) hypothesis of cancer causation by low radiation doses, the theoretical basis for past radiation phobias. Despite this advance, many government and private agencies stick with this outdated idea because of institutional or bureaucratic inertia.

– Chest CT scans pick up lung cancers when most are small enough to be cured. In a 1999 article in the Lancet medical journal, Claudia I. Henschke, M.D., Ph.D., and others at New York Weill Cornell Center reported using chest CT to examine 1,000 people at high risk for lung cancer. They found 19 tiny cancers not detected by other tests and invisible on standard chest x-ray. They estimate that chest CT scans “could save more than 100,000 lives annually in the United States by detecting lung cancer at an early, curable stage.” Dr. Henschke also says “CT screening transforms the prognosis for lung cancer, just as mammography did for breast cancer and the PAP test did for cervical cancer.”

– The history of scanning is that the cost and radiation dosage decrease significantly with time.

– Unlike acute illness where tests may be done daily and weekly, or chronic illness where they may be done monthly or yearly, a screening whole body CT scan would not usually be done more than once every several years.

Qualified radiologists perform screening CT examinations using up-to-date equipment in all the services we’ve looked into. David J. Klingler, Chief Operating Officer of Virtual Physical near Baltimore, Md., tells us that all requests for screening CT examinations are reviewed for appropriateness. Virtual Physical refuses to screen anyone under age 30. People with any significant medical symptom are referred immediately to a primary care physician for evaluation.

Myron Pollycove, M.D., of the U.S. Nuclear Regulatory Commission and professor emeritus of Laboratory Medicine and Radiology at the University of California at San Francisco, notes that cancer occurs more frequently in each older age group so that screening of older people, especially over age 45, is more likely to be beneficial.

Most screening scans do not find major abnormalities, usually greatly reassuring the patient. Craig Bittner, M.D., a Stanford and UCLA trained radiologist at AmeriScan in the Phoenix area, tells us “patients love it.” Dr. Bittner tells about a middle-aged man who was planning to start a family; he was concerned because he was older than the average man starting a family and he might not be able to take care of his planned family if he had a hidden or occult cancer. He was overjoyed when his scan found no evidence of cancer. The reassurance from the scan was well worth the time and expense for this man – and for many other people. We’d rather manage and cure such mild fears than engender new, groundless ones.

Of course, you don’t want to have such an examination if you don’t want to. Everybody can make their own decision about the trade-offs between the potential benefits and potential risks of this totally voluntary medical examination. After all, the decision to do the examination is made by mutually consenting adults, the patient and the doctor. In our freedom-loving society, we find this expression of human freedom healthy and refreshing.

We hope that unfounded radiation fear and fallacy will not deter those who choose to have a study that possibly could save their life. The decision to have – or not have – a screening whole body scan is really a matter of freedom and patient choice.

Michael Arnold Glueck, M.D., of Newport Beach, Calif., writes extensively on medical, legal, disability and mental health reform. Robert J. Cihak, M.D., of Aberdeen, Wash., is president of the Association of American Physicians and Surgeons. Both doctors are Harvard trained diagnostic radiologists. Collaborating as The Medicine Men, they write a weekly column for WorldNetDaily as well as numerous articles and editorials for newspapers, newsletters, magazines and journals nationally and internationally.