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.
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.
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?