Ever been to the doctor, mention you aren't feeling well, that you may be having symptoms that may be something serious or not?
Without much thought to your symptoms, the doctor orders a CT scan. Maybe two in a matter of weeks.
A CT scan while valuable for a diagnosis may also contribute to cancer because of its ionizing radiation.
In April, a Journal of American Association study was published titled "Projected Lifetime Cancer Risks From Current Computed Tomography Imaging."
That study asked: "How many future cancers could result from radiation exposure from annual computed tomography (CT) examinations in the United States?"
It is a surprising number. The study reported that the 93 million CT scans performed in 62 million patients in 2023 were projected to result in approximately 103,000 future cancers.
Think about that for a minute. The scans used to diagnose cancer could cause people to actually develop cancer.
The study noted, "the per-examination cancer risk was higher in children." Yet, "higher CT utilization among adults accounted for the majority of the projected cancers." That means CT-associated cancers could eventually account for 5% of all new cancer diagnoses annually.
Look at how many scans were performed in 2023 – 62 million patients underwent 93 million CT examinations in the United States.
"CT use is 30% higher today than in 2007, due to growth in low-value, potentially unnecessary imaging" according to the study.
The study breaks the scans down by sex and organ-specific radiation doses.
The most common cancers were lung cancer (22,400 cases; 90% UL, 20,200-25,000 cases), colon cancer (8700 cases; 90% UL, 7800-9700 cases), leukemia (7900 cases; 90% UL, 6700-9500 cases), and bladder cancer (7100 cases, 90% UL, 6000-8500 cases) overall, while in female patients, breast was second most common (5700 cases; 90% UL, 5000-6500 cases). The largest number of cancers was projected to result from abdomen and pelvis CT in adults, reflecting 37 500 of 103 000 cancers (37%) and 30 million of 93 million CT examinations (32%), followed by chest CT (21 500 cancers [21%]; 20 million examinations [21%])
One startling point in the study: "Several large retrospective cohort studies have shown that childhood exposure to CT is associated with increased risk of hematologic malignant neoplasms and brain cancer."
Also of note: Evidence shows that CT damages DNA in adults.
Why is this critical? The National Institutes of Health have identified at least 50 hereditary cancer syndromes caused by mutations in over 100 diffetent genes These dispositions account for 5% to 10% of all cancer diagnoses. For example, Lynch syndrome is one.
A person will not likely know they have one of these hereditary cancer syndromes without genetic testing. Most people do not undergo genetic testing because doctors don't insist on these tests. If a doctor suspects you may have cancer, he or she may order a CT scan. That scan alone will expose you to more radiation. For those with a genetic defects, that radiation and more CT scans can damage your DNA.
Exposure to more radiation can increase a Lynch syndrome patient's risk for secondary cancers. People with this syndrome have defective DNA mismatch repair (MMR) genes – the very genes crutucally needed for fixing radiation-induced DNA damage. Their ability to repair DNA damage is impaired.
Radiation treatment for cancer and radiation exposure for CT scans should be weighed heavily.
Demand safer imaging practices
The University of California San Francisco developed a Medicare-adopted measure in 2023 to standardize and limit excessive radiation doses, holding hospitals and doctors accountable.
New measures include discouraging high-dose radiation, implementing more regulation of radiation levels and the necessity of CT scans.
According to KFF Health News, "The American College of Radiology and three other associations involved in medical imaging, however, objected to the draft CMS rules when they were under review, arguing in written comments in 2023 that they were excessively cumbersome, would burden providers, and could add to the cost of scans."
However, the same article states: "The group was also concerned, at that time, that health providers would have to use a single, proprietary tech tool for gathering the dosing and any related scan data.
The single company in question, Alara Imaging, supplies free software that radiologists and radiology programs need to comply with the new regulations. The promise to keep it free is included in the company’s copyright."
Enter Washington bureaucracy
Now, it appears any mandate for radiation change won't happen. This now may be voluntary. Safeguards for excessive radiation will be removed. More avoidable cancers will likely occur.
Alara Imaging has initiated a campaign asking people to send a letter to Washington to prioritize patient safety by Sept. 15.
You can fill out the form letter here.
It says:
"Dear CMS leadership,
I strongly oppose CMS’s proposed change in reporting requirements for the Excessive Radiation quality measure. I firmly believe that reporting should remain mandatory within the Hospital Outpatient Quality Reporting Program, rather than voluntary. Radiation exposure from CT scans is a serious issue that directly impacts patient safety. Patients trust hospitals to use medical imaging responsibly and to avoid exposing them to unnecessary risks.
The recent study estimating that CT scans may cause 103,000 cancers a year highlights the urgency of this issue. As someone who actively works to reduce my personal cancer risk, I find it unacceptable that preventable factors such as excessive radiation are not being adequately addressed. Mandatory reporting of the Excessive Radiation measure is a vital tool to ensure hospitals are actively reducing unnecessary exposure. Voluntary reporting is simply not enough to protect patients and hold hospitals accountable.
Patients deserve to know that their health and safety are prioritized, and that every effort is being made to minimize risks associated with CT scans. I urge CMS to safeguard patient health by maintaining mandatory reporting requirements for this measure.
Thank you for considering this critical matter. I trust that you will act in the best interests of patients everywhere."
Read more about Alara, which stands for "As Low As Reasinably Achieveable," here.
