CT chest scans can save lives, but they often do more harm than good

Scanning for dollars

If you had heart disease, would you want to be treated in 2011 or 1911?

No contest, right? Modern medicine is far from perfect, but it is, well, modern. Give it that.

But one of the biggest drawbacks of modern medicine is the rampant overuse of diagnostic tools and treatments. (After
all, that high-tech machinery doesn’t pay for itself!)

A few days ago I told you about a dirty little scandal that few outside the medical industry know about. It seems that many doctors unnecessarily order double computed tomographic scans of the chest.

In most cases, a single CT scan is sufficient. But in hospitals all across the country, when doctors call for one scan, many will call for a second scan — mostly among patients with Medicare benefits.

Medicare covers the bills for these unnecessary extra scans, while patients are needlessly exposed to very high, unsafe levels of radiation.

Now a new report from Johns Hopkins here in Baltimore finds that in many cases patients are much better off not even
getting that first CT scan.

More harm than good

If you develop a heart disease symptom such as chronic chest pain, your doctor may want to get a look inside. That’s what a coronary CT angiogram provides. In fact, it creates a pretty impressive 3D image of your heart.

But if you don’t have any clear symptoms of artery problems or heart disease, is it reasonable to use a CT scan as a
precaution?

To answer that question, Hopkins researchers reviewed 18-months of medical records for 2,000 subjects. Half of the group received a CT scan, while the other half received a standard checkup.

A year and a half later, there was one clear difference between the two groups…

Subjects in the CT scan group were given more heart procedures, more follow-up tests, and more medications (primarily statins and aspirin) than subjects who didn’t get scanned.

And what was the benefit of all that extra treatment?

Nothing.

Rates of heart attacks, heart disease deaths and other cardiac events were the same in both groups.

Lead researcher, Dr. John W. McEvoy, told the Chicago Sun Times that CT testing in patients with low or intermediate¬† risk of atherosclerosis doesn’t appear to be useful, especially when excessive radiation exposure, unnecessary follow-up procedures, and drugs with unhealthy side effects become part of the package.

A few days ago I told you to beware of any doctor who recommends a double CT scan. Obviously, we need to revise that a bit: If your heart disease risk is slight and your doctor recommends a CT scan, it’s time to get a second opinion — BEFORE you get even a first CT scan.

Sources:
“Impact of Coronary Computed Tomographic Angiography Results on Patient and Physician Behavior in a Low-Risk Population” Archives of Internal Medicine, Published online ahead of print 5/23/11, archinte.ama-assn.org

“Some heart screenings may do more harm than good” Monifa Thomas, Chicago Sun Times, 6/25/11, suntimes.com

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