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August 28-29, 2013 CANCER HEALTHY LIFE 11
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By ZANE SPARLING
Pamplin Media Group
In 2013, thousands of Oregonians will
undergo a MRI or CT scan.
Whether the scan is part of a routine
annual check-up, or the first step in
screening for cancer, for the most part, pa-
tients will undergo imaging procedures only
when it is recommended by
their primary care physician
or a specialist.
But for a growing number
of concerned and health-con-
scious patients, waiting for
“doctor’s orders” just won’t
cut it.
On a hunch or due to a per-
sonal preference, many pa-
tients prefer to order a CT
scan based on their own de-
sire to detect cancer or other
health concerns without the prior approval of
a doctor.
Not surprisingly, confusion, contention and
controversy surround the issue of out-of-pock-
et, patient-ordered scans.
Among the questions yet to be settled: Do
patient-ordered CT scans catch more cases of
cancer earlier, or are patients merely subject-
ing themselves to unnecessary worry, radia-
tion and the risk of false positive results?
More to the point: Does paying out-of-pock-
et for a CT or MRI screen ever make sense?
Dr. Jordan Fein, a pulmonologist at the Leg-
acy Cancer Institute, said patients should
think twice before ordering their own CT scan.
“Screening is not an isolated event,” Fein
said. “It needs a framework of interpretation.
And it has to be done at a center where (con-
sultation is done by) a group of multidisci-
plinary doctors.”
Fein said a single screening —whether it
detects any possible cancerous growths or not
— just doesn’t provide enough information for
a patient acting on their own.
A cancerous nodule could be a false positive
while an “all clear” result might lead a patient
to assume nothing is wrong.
And false positives aren’t all that uncom-
mon.
A 2009 study by the National Center for Bio-
technology Information showed that, for at
least some types of cancer screening tests, pa-
tients who undergo 14 screenings have more
than a 50 percent chance of a false positive re-
sult.
To verify either result, doctors rely on mul-
tiple interpretations of multiple screenings.
These re-screenings and re-interpretations al-
low doctors to develop a clearer picture of
their patients’ medical state and to eliminate
false positives.
Essentially, any irregularity picked up by a
CT or MRI scan might be cancer, but radiolo-
gists study how the nodule changes through
time and reacts to stimuli over weeks or
months to determine whether or not an aber-
ration is cancerous.
“I don’t recommend (self-selected scanning)
to patients,” Fein said. “When something’s
been found but no (physician) is ensuring that
the patient gets a follow-up, either in three
months or a year. The potential benefit is out-
weighed by the risk.”
OHSU radiologist Dr. Karen Oh has a differ-
ent point of view.
As the director of breast imaging, Oh said
that a woman’s right to order a mammogram
or other scan was protected by law for a rea-
son.
“Some women just start (ordering mammo-
grams) on their own, which is fine,” Oh said.
“The positives are that you can catch cancer
earlier, and hopefully avoid the risks of more
extensive surgery.”
Oh said that many doctors recommend old-
er women schedule regular screening for
breast cancer every year, or every other year,
depending on their risk factors and age.
“In my opinion, I’d rather get the screening
than potentially not find the cancer.” Oh said.
But there’s also a financial cost.
While insurance companies cover CT scans
when there’s an appropriate reason, when
self-directed, Oregonians can expect to pay
anywhere from $400 to $1,000 out of pocket.
And while CT scans remain a valuable diag-
nostic tool, each imaging subjects the patient
to 150 to 200 times more radia-
tion than the average chest X-
ray.
So when should you under-
go a CT scan, MRI imaging or
mammogram?
According to Fein, the aver-
age person should first con-
sider asking their primary
care provider for a CT scan if
their family history indicates
an increased risk.
Oh suggested that if a pa-
tient develops any unusual lumps, growths or
protrusions, that’s another warning sign that
should be immediately followed up on.
And finally, if a person engages in any activ-
ity known to increase the likelihood of devel-
oping a certain type of cancer — such as
smoking cigarettes and lung cancer — then a
CT scan may be a smart idea.
To screen or not to screen?
fEIN OH