Hopefully this isn’t breaking rules. Yes it is a veiled attempt at advice because I’ve been hemming and hawing. But the question can be answered purely as is. There are obviously pros and cons so I’d like to know how you all feel.
Thank you.
Yeah, I’d like to know if my uterus is actually trying to kill me of if it’s all in my head like every doctor who refuses to let me finish a sentence before they start talking over me, tells me.
Endometriosis?? I’ve heard that sucks major ass. I actually work at a hospital where patients get a bunch of tissue from their abdomen/pelvis removed when it is involved by endometriosis. I always wondered if that helped these patients much or not.
Endometriosis can be really fucking crazy too. I’ve very rarely seen it do wild as fuck things like explode an appendix or even cause a bowel obstruction!!!
I’m less worried about that and more PCOS. But I’ve been trying to treat myself as if I have it, like eating better and that kind of thing. I actually have a new doctor who actually let’s me talk about things for the first time in my life (I’m nearly 40) so we’re going to discuss that and peri menopause next month.
Not sure if you’ve heard, but the medical world is slowly trying to transition to calling it PMOS now. Polyendocrine metabolic ovarian syndrome. Basically, research has concluded that the ovarian cysts are a symptom of much larger metabolic and insulin resistance issues. So they’re trying to move towards referring to it as an endocrine and metabolic issue, instead of an ovarian cyst issue.
The fact that many doctors don’t tend to take women’s issues seriously is a factor in the name change. Language shapes how we view the world, and referring to it specifically as an issue with ovarian cysts has lots of doctors automatically dismissing it as whiny women complaining about their periods. But calling it an endocrine and metabolic issue is more accurate and may encourage some doctors to actually take the symptoms more seriously.
I’ve heard it’s been talked about but I didn’t know it was official! Thanks.
Ah gotcha! There are actually a lot easier ways to find out if PCOS is on the table. Blood hormone tests and ultrasounds can help and are super easy for an office to do! Hope your doctor actually wants to help you out and investigate these things.
My fingers are crossed with her. Our initial conversation went well!
My wife has it, and from what I have witnessed… It’s the worst. Even when you do the thing that is supposed to fix it … It’s not always going away
You do NOT want an unnecessary scan. There is a common misconception that knowledge in this arena is good. While the scan itself is not dangerous, what you would be required to do with the information is. Almost everyone has some abnormalities, we call them “incidentalomas”. Knowing about them will cause unneeded biopsies and months to years of worry that “you have cancer” or " something is not right". There is a reason that there are strict screening recommendations in medicine. Unless a disease has a long preclinical (pre-symptom) phase with a clear improvement in outcomes from early treatment ( no lead time bias) then screening ( testing without symptoms to make sure nothing is there) is openly harmful and should not be done.
Haha yes I work in healthcare and we used the world “incidentaloma” when I was in school lolol.
Sometimes things diagnosed incidentally do save people’s lives though. I had an uncle diagnosed with renal cancer indicidentally when they were imaging him for some other reason. He had the kidney removed and has been cancer free forever now…might have been more than a decade ago. In many cases, a random scan can save someone’s life.
But the other hand causes things you describe, unnecessary stress and intervention for otherwise benign but odd things that people see. It’s one of the big reasons why you don’t generally just get an MRI just to get one.
I’ve been fighting back and forth with what to do in my mind here.
https://doi.org/10.1136/bmj.k2387
Let’s go through a bayesian analysis hypothetical.
Rates of incidental findings on MRI are about 30%. So if 100 people get a scan 70 are reassured. 30 find something. Of those 30, about 2 to 5 percent are malignant so rounding up 2 find malignancy and 28 find a mass that needs follow up/biopsy. 28 are measurably harmed. Now let’s look at the 2. You have identified cancer “early” in these two people. Did you help them, well that depends on what you find. Some cancers (pancreatic, breast, melanoma) finding early is really the only chance at cure. For others, all you have done is make them worry about their disease for longer (lead time bias). If treatment in the preclinical ( pre-symptom) phase does not help more than treatment after symptoms then all you have done is given someone the knowledge that they have cancer for months or years longer than they otherwise would have needed it. You did not improve their mortality or morbidity.
Most of the diseases that have a preclinical phase where intervention is helpful already have screening recommendations. So odds are whatever you find is not one of those cancers that would be helpful to find early.
Ultimately, it’s your health and your choice. If you are having symptoms or have a genetic history that puts you at higher incidence it might make sense. For the general, asymptomatic population, the positive predictive value of this test is very low. So low that it is clearly harmful and should not be done.
Everyone has heard that story of the friend or family member that “was in an accident” but it ended up saving them because they found cancer. While That certainly has happened, it is exceedingly rare and often not the full picture.
*Edited a typo
might cause you stress, or might lead you to finding something before it ends up threatening your life? There’s a whole lot of stress-inducing shit going around right now. Saying stress is potentially dangerous is true, but shouldn’t be used as an excuse not to get imaging done.
And here we go with the typical thread of “I spent 2.6 seconds vaguely thinking about this so now I know better than any of those so called experts; I should now go online and educate people about the issue. If there is a counterargument, I will double down using only my common sense as source and ignore any input.”
I have a medical degree.
Then why do you equate stress with biopsy?
As long as they let me keep the scan file. I love me some volunetric data.
I mean… Sure? It doesn’t cost me anything to do it, so might as well ¯\_(ツ)_/¯ maybe they’ll find something
The more you look, the more you’ll find. Those pictures may give you answers you didn’t want to hear.
Sometimes the answers you don’t want to hear are the ones you need to hear.
There was a recent study that took MRIs of people over the age of 40, with and without shoulder pain. In 99% of cases, there was a shoulder abnormality. It was just that most people did not feel it or were not bothered by it.
It depends. Many people have something odd going on here and there, but most of it doesn’t really require medical intervention. Some of those things actually go away sooner or later anyway, so an intervention can do more harm than good. Chances are, it’s just going to freak you out for nothing, and cost you money.
The thing is, you never know. There’s always a chance that something truly horrifying is brewing inside you, and ignoring it is going to cost you your life, or worse. What if you’re one of the lucky few who need to get something fixed before it becomes a serious issue? Who knows.
The way I see it, the expected value of this equation is pretty harmless. If you feel completely normal, it’s probably nothing.
A second opinion is an option. And a better one than a bunch randos on the internet who don’t know anything but that you’re questioning your doctor’s recommendation.
I’ll copy a reply I said to someone else.
“Well it’s funny because they are the second opinion I was referred to. Had an odd result to something so I wanted to make sure it was fine. The second opinion also said it was fine which made me relieved, but then they asked if I wanted an MRI. At first I was like well ok sure I met my deductible but now I’m like wtf am I even thinking.”
I would go with the second part of your message here and skip it UNLESS you are having symptoms and think there is really something the scans missed.
I actually had an incidental scan, was getting a “Coronary Artery Scan” because I’ve had always high cholesterol - it came back perfect, no buildup but they found benign little masses in my liver - doctor says absolutely normal and I understand why they would look (free knowledge for me) but I think I would be a little better off not knowing that.
The real question is: do you have to pay for it?
Yes but my insurance sucks and I somehow managed to meet my very high deductible this year. I can’t see that happening again in the near future. So it’s probably the cheapest I’d ever get an MRI lol…that part is part of the reason I’m considering doing it.
Insurance says it was approved so I would pay 20%. Normally when I haven’t met my deductible (most years), I would be paying 100%. I am comfortable financially to pay for something at 20%.
I did and it ended up saving my life
Your mileage may vary.
What happened of you don’t mind me asking?
They found a tumor, stage 1 cancer.
Luckily it was trivial to remove at that stage.
Damn! Very glad to know you’re still with us! Was it suspected or totally unrelated to why you got the imaging?
I had a family history, but nothing where a doctor definitely said I needed to get one.
That said, when you get an MRI, you’ll get a full report including anything that they see that they don’t think is a problem. There other items that they found with the MRI that they identified weren’t an issue, but they did note one mass that was later identified as cancerous.
hey if you can afford the cost, there’s literally no downside. Maybe you catch something before it becomes a big life threatening thing. do it.
If there’s no medical reason to get it, I wouldn’t bother.
100%. As someone said they are not in themselves dangerous and the only danger is taking something from it and doing something unnecessary. Don’t do that. If something is not imminently dangerous then wait and see. Unless you live in a country where you might have healthcare now but not later of course.
Well bois…I’m fucked because now I missed the cutoff to cancel it
I would trust my doctor for advice. I’ve been in that tube a few times-my body can’t lie still for that long and then they get mad because I moved meaning the machine alignment gets of and they need me in longer while they recalibrate. Thus if not needed I wouldn’t - but if needed, well I’m still walking today because of what it found.
If I’m still on state insurance? Sure sign me up. I’m good with going into the machine. Without insurance? You paying? Okay? Me paying? Guess I’m dying.
are you me?
Extremely unlikely. I already have one clone, I don’t think I have others!
A long as I’m not paying and I am statistically likely to survive more than one afternoon longer if I decide to bother showing up.
