3 ms·

Yeah, I've read all the arguments about harm, and I just don't buy it. I'd get a CT scan every year if I could convince someone to sign off on it. There is abso

Yeah, I've read all the arguments about harm, and I just don't buy it. I'd get a CT scan every year if I could convince someone to sign off on it. There is absolutely no substitute for knowing.

themantalope 4y ago
Until you've had an unnecessary biopsy that kills you :)
kashunstva 4y ago
> I'd get a CT scan every year You would choose annual body CT even if outcomes-based evidence showed no benefit? Even among those at highest risk for lung carcinoma, studies of annual screening chest CT do not uniformly show improved disease-specific survival as compared to an unscreened but otherwise matched cohort.
- themantalope 4y ago
  https://www.nejm.org/doi/full/10.1056/nejmoa1102873 https://www.nejm.org/doi/full/10.1056/nejmoa1102873 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3762603/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3762603/ What I found mind blowing when I first read these studies (particularly the second link) is that the positive-predictive value of the CT screen was only 3.8% for lung nodules that were 4mm or larger in size. Basically just means we find all kinds of lung abnormalities all the time that "could be cancer" but aren't. Keep in mind, that the screening criteria was people over age 65 who had a 30+ pack-year smoking history (1 pack-year = smoking 1 pack of cigarettes per day in one year), and had to have smoked within the last 15 years. I can also tell you from doing CT lung biopsies that it's not a procedure to take lightly. Lot of important structures in the chest.
- quasarj 4y ago
  Absolutely. Those studies show no improved survival across cohorts. Not for individuals. My only chance of living is to know. That's worth it for me. I mean, plus I have extreme health anxiety, and I've had doctors say "nah you're too young, we don't need to test for that" and later it turned out I did have kidney failure at 35.
selectodude 4y ago
You’d dramatically raise your risk of cancer from x-ray exposure for almost zero clinical benefit.
- quasarj 4y ago
  Yeah, that is the only concern. I guess whole-body MR would be fine too. I'd be willing to lay in the tube for 20 hours a year to know that I'm at least structurally normal still.
  - ska 4y ago
    > Yeah, that is the only concern. It really isn't. Your chances of negative consequence for unnecessary follow up procedures would rapidly become significant.
KennyBlanken 4y ago
> Yeah, I've read all the arguments about harm, and I just don't buy it. "I have no medical background whatsoever but I do not buy undisputed medical science." > I'd get a CT scan every year if I could convince someone to sign off on it 20mSv of unnecessary ionizing radiation exposure a year, what could possibly go wrong? That whole-body CT scan is equivalent to getting at least EIGHTY chest x-rays, and ten times what a uranium miner receives in a year, and well within the range where an increased risk of cancer is noticeable in epidemiological data. Case and point why this tool should not be generally available.

Yeah, I've read all the arguments about harm, and I just don't buy it. I'd get a CT scan every year if I could convince someone to sign off on it. There is absolutely no substitute for knowing.

themantalope 4y ago

Until you've had an unnecessary biopsy that kills you :)

kashunstva 4y ago

> I'd get a CT scan every year You would choose annual body CT even if outcomes-based evidence showed no benefit? Even among those at highest risk for lung carcinoma, studies of annual screening chest CT do not uniformly show improved disease-specific survival as compared to an unscreened but otherwise matched cohort.

themantalope 4y ago
https://www.nejm.org/doi/full/10.1056/nejmoa1102873 https://www.nejm.org/doi/full/10.1056/nejmoa1102873 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3762603/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3762603/ What I found mind blowing when I first read these studies (particularly the second link) is that the positive-predictive value of the CT screen was only 3.8% for lung nodules that were 4mm or larger in size. Basically just means we find all kinds of lung abnormalities all the time that "could be cancer" but aren't. Keep in mind, that the screening criteria was people over age 65 who had a 30+ pack-year smoking history (1 pack-year = smoking 1 pack of cigarettes per day in one year), and had to have smoked within the last 15 years. I can also tell you from doing CT lung biopsies that it's not a procedure to take lightly. Lot of important structures in the chest.
quasarj 4y ago
Absolutely. Those studies show no improved survival across cohorts. Not for individuals. My only chance of living is to know. That's worth it for me. I mean, plus I have extreme health anxiety, and I've had doctors say "nah you're too young, we don't need to test for that" and later it turned out I did have kidney failure at 35.

selectodude 4y ago

You’d dramatically raise your risk of cancer from x-ray exposure for almost zero clinical benefit.

quasarj 4y ago
Yeah, that is the only concern. I guess whole-body MR would be fine too. I'd be willing to lay in the tube for 20 hours a year to know that I'm at least structurally normal still.
- ska 4y ago
  > Yeah, that is the only concern. It really isn't. Your chances of negative consequence for unnecessary follow up procedures would rapidly become significant.

KennyBlanken 4y ago

> Yeah, I've read all the arguments about harm, and I just don't buy it. "I have no medical background whatsoever but I do not buy undisputed medical science." > I'd get a CT scan every year if I could convince someone to sign off on it 20mSv of unnecessary ionizing radiation exposure a year, what could possibly go wrong? That whole-body CT scan is equivalent to getting at least EIGHTY chest x-rays, and ten times what a uranium miner receives in a year, and well within the range where an increased risk of cancer is noticeable in epidemiological data. Case and point why this tool should not be generally available.