After suffering a heart attack in 2004, I was directed by my first cardiologist to go in annually for nuclear imaging. Test after test showed near normal function despite the noticeable but relatively minor muscle damage. My last scan in 2009 came back with a twist, though. The heart looked good but a white spot showed up in my chest that looked like a cancer. This necessitated me going in for a CT scan. It came back negative (no cancer). Nevertheless I spent a couple of weeks in a state of high suspense.
Now I’m undergoing underwriting for a key-man insurance policy for my company. Maybe I will need to go back in for another nuclear imaging. Although it will be useless to push back on this, my current cardiologist says there’s no need to spend the money and expose me to the radiation so long as I’m not exhibiting any changes in my heart health (I am not).
My point is that one should not assume that it’s always good to get testing, both because of its inherent dangers and because of the chance of false positive results—mistakes that can be very costly for the patients psyche. Also, the outright costs of over-testing cannot be overlooked. In this case I got irradiated two-fold by the nuclear imaging and then by the CT’s x-ray bombardment. (Is it irony that a test for cancer increases ones chance of cancer?)
My friend Rich put me on to this very-informative podcast by Minnesota Public Radio (MPR) featuring a talk, aired on June 30, by Dr. Jerome Goodman and his wife, Dr. Pamela Goodman on how to make medical decisions. Not only are both partners in this couple outstandingly qualified to speak on these matters, they bring quite different perspectives on how to weigh the risks of tests and treatments versus the potential benefits.
For example, a middle-aged woman is told that her cholesterol being above 200 exceeds the level considered safe for her heart-health. She is advised to go on statins to reduce the risk of heart attack by 30 percent. However, some research by this patient uncovers the statistic that women of this age only face a 1% risk of such a catastrophic event whereas 1 to 10% of those going on statins suffer the side-effect of myopathy—a painful and debilitating muscular disease. As a result of this woman doing her homework, she decides not to take the doctor’s advice. Does that make sense?
There really is no right answer for any of these medical decisions, but it surely is worth pressing your physician for data on risks versus benefits, doing your own research and, if it’s important enough, getting a second opinion.
#1 by BobH on October 7, 2014 - 12:49 pm
What is “nuclear imaging”? If you are referring to MRI then there is no “exposure” when you are in a magnet. I assume you mean nuclear tracers though.
It is always misleading to see percentages of risk. A 30% increase of a 1:10M (million) risk is insignificant yet that is what is in your article and in most media. Most doctors still don’t know this, in my experience.
#2 by mark on October 7, 2014 - 1:18 pm
As NIH describes it the nuclear imaging I had done on my heart requires “a safe, radioactive substance called a tracer” to be “injected into your bloodstream.” Maybe it really is safe but one will trigger the airport security radiation alarms by rushing immediately off to a flight afterward.