Yearly Archives: 2007

Consequences of mucositis-induced treatment breaks and dose reductions on head and neck cancer treatment outcomes

  • 12/4/2007
  • Houston, TX
  • DI Rosenthal
  • J Support Oncol, October 1, 2007; 5(9 Suppl 4): 23-31

Patients with head and neck cancer (HNC) receiving radiation therapy (RT) alone or with concurrent chemotherapy (CRT) often develop mucositis that may lead to unplanned treatment interruptions and/or chemotherapy dose reductions.

Some RT schedules have included planned treatment breaks to allow normal tissues to recover from these toxicities. These decreases in treatment intensity, however, may reduce rates of locoregional tumor control and survival.

Any treatment gaps allow for tumor repopulation, which may also promote regrowth of chemotherapy-resistant populations. Therefore, any potential benefits of high-intensity therapy may be lost due to interruptions in RT or reduced chemotherapy dose intensity, unless the treatment intensity is sufficient to offset interval tumor repopulation.

Most patients undergoing RT alone and virtually all undergoing CRT–particularly those with HNC–will develop mucositis, which doubles the risk of reduction in treatment intensity and can increase the rate of hospitalization and the use of feeding tubes or total parenteral nutrition. Many of these patients with severe mucositis will require a break in treatment or change in administration schedule to alleviate symptoms. Effective prophylaxis or treatment could reduce the probability of treatment breaks and dose reductions and thus improve outcomes.

Author’s affiliation:
Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Box 0097, Houston, TX 77030, USA

December, 2007|Archive|

UVA Program Improves Health Of Cancer Patients

  • 12/3/2007
  • Charlottesville, VA
  • Cheryn Stone
  • 19News (www.charlottesvillenewsplex.tv)

A program through the UVa Cancer Center is saving patients money and making a big difference in their health.

Doctors are giving away free nutritional supplements to patients. Doctors say this can really decrease weight loss, and it’s getting patients the calories that are critical to their health.

Through surgeries, radiation, and chemo, weight loss can be a big problem for patients fighting cancer.

Dr. Paul Read with UVa Radiation Oncology says, “there’s a lot of quality of life data that says if cancer patients lose weight that’s a very good sign that a they are not going to feel well, they’re not going to feel fit, and they may not be able to tolerate these treatments we put them through.”

Nutritional supplements can help the patients get through it.

Dr. Read adds, “there’s also data that suggest that if patients don’t lose weight and they can get through their treatments as we initially prescribe them, we’ll have a better chance of curing them.”

So now doctors at the UVa Cancer keep cases of Ensure on hand to hand out to patients.

“We saw a real need to help many of our patients who are having nutritional problems get through their treatments by supplying them with nutrition in our clinic,” Dr. Read says.

Three years and 2,500 cases of Ensure later, UVa doctors have given out 21 million calories so far.

Doctors say sometimes drinks like these are all patients can drink for their nutrition, so access to these calories is crucial throughout their treatment.

The program started with head and neck cancer patients, but now it has grown to help those fighting other cancers too.

UVa doctors have given 1,200 cases of Ensure this year alone.

Dr. Read says he would like to see a program like this spread to other cancer centers across the country.

December, 2007|Archive|

Iditarod winner and cancer survivor

  • 12/3/2007
  • web-based article
  • staff
  • google-sina.com

Lance Mackey beat cancer back in 2001 and on Tuesday he won the Iditarod Trail Sled Dog Race in Nome, Alaska. Mackey was diagnosed with neck cancer in 2001 and received surgery and radiation for his treatment.

Lance owns a kennel named Lance Mackey’s Comeback Kennel. He indeed made a comeback, he has back to back wins in the Iditarod Trail Sled Dog Race and the Yukon Quest International Sled Dog Race.

Mackey’s status as a cancer survivor and champion musher will inspire other people with cancer, said Christine Schultz, 42, of Nome, a medical social worker who stood out in subzero temperatures with co-workers from Norton Sound Regional Hospital to watch Mackey cross the finish line. “I think it gives people hope they can overcome cancer and live their dreams,” she said.

Don’t ever doubt I can’t do something,” Mackey said in Nome after his win. “I lived through cancer.”

OCF Note: This is a news story that we picked up off the general newswires. We put it here to show other cancer patients that even after a battle with this disease, that life can be more than survival, it can be good and that they can return to a full life. It is about cancer, not about the Iditarod. We have been contacted by advocates for the dogs used in these races, detailing the hard and sometimes harsh life, and sometimes even cruel manner in which they are treated. We are not endorsing any cruel treatment of these beautiful animals, nor promoting the race itself. We are using a story that was put out in the general media by others to illustrate that even after a battle with a deadly disease, life can go on. If you read the story including the quote from the medical worker we think this is clear. We applaud the work of those that endeavor to better the treatment of these animals, but wish them to understand we are not reprinting a story about the race, the dogs, the harsh life they lead, or glorifying something that has caused harm. It is a story about life after cancer – and in writing us, we think they should keep perspective on the intentions of people that like them, are trying to see a better world.

December, 2007|Archive|

Lack of Association of Alcohol and Tobacco with HPV16-Associated Head and Neck Cancer

  • 12/2/2007
  • web-based article
  • Katie M Applebaum et al.
  • J Natl Cancer Inst, November 27, 2007

Background:
Human papillomavirus type 16 (HPV16) seropositivity and alcohol and tobacco use have been associated with risk of head and neck squamous cell carcinoma (HNSCC). However, it is less clear whether HPV16 influences HNSCC risk associated with alcohol and tobacco use.

Methods:
Incident cases of HNSCC diagnosed between December 1999 and December 2003 were identified from nine medical facilities in Greater Boston, MA. Control subjects were frequency matched to case subjects on age, sex, and town of residence. A total of 485 case subjects and 549 control subjects reported information on lifetime smoking and alcohol consumption and provided sera, which was used to determine presence of HPV16 antibodies. Unconditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of HNSCC risk by alcohol consumption (drinks per week: <3, 3 to <8, 8 to <25, >/=25) and smoking (pack-years: none, >0 to <20, 20 to <45, >/=45), adjusting for age, sex, race, education, and HPV16 serology. Polytomous logistic regression was used to estimate odds ratios and 95% confidence intervals for the association of HPV16 serology, alcohol consumption, and tobacco use in site-specific analyses. All statistical tests were two-sided.

Results:
The strongest risk factors by tumor site were smoking for laryngeal cancer, alcohol for cancer of the oral cavity, and HPV16 for pharyngeal cancer. For pharyngeal cancer, risk increased with increasing alcohol consumption (OR(>/=25 versus <3 drinks per week) = 5.1, 95% CI = 2.4 to 11.0) and smoking (OR(>/=45 pack-years versus never smoker) = 6.9, 95% CI = 3.1 to 15.1) among HPV16-seronegative subjects but not among HPV16-seropositive subjects (P(interaction, HPV16 serology and alcohol) = .002; P(interaction, HPV16 serology and smoking) = .007). Among light drinkers or never smokers, HPV16 seropositivity was associated with a 30-fold increased risk of pharyngeal cancer.

Conclusions:
Alcohol or tobacco use does not further increase risk of HPV16-associated pharyngeal cancer. HNSCC risk associated with smoking, alcohol, and HPV16 differs by tumor site.

Authors:
Katie M Applebaum, C Sloane Furniss, Ariana Zeka, Marshall R Posner, Judith F Smith, Janine Bryan, Ellen A Eisen, Edward S Peters, Michael D McClean, and Karl T Kelsey

Authors’ affiliations:
Affiliations of authors: Departments of Environmental Health (KMA, EAE, KTK) and Genetics and Complex Diseases (CSF), Harvard School of Public Health, Boston, MA; Institute for the Environment, University of Brunel, West London, U.K. (AZ); Head and Neck Oncology Program, Dana-Farber Cancer Institute, Boston, MA (MRP); Department of Vaccine Biologics Research, Merck and Co, Inc, West Point, PA (JFS, JB); Epidemiology Program, Louisiana State University Health Sciences School of Public Health, New Orleans, LA (ESP); Department of Environmental Health, Boston University School of Public Health, Boston, MA (MDM); Departments of Community Health and Pathology and Laboratory Medicine, Center for Environmental Health and Technology, Brown University, Providence, RI

December, 2007|Archive|

A Survey of the Current Approaches to Diagnosis and Management of Oral Premalignant Lesions

  • 12/2/2007
  • web-based article
  • Joel B. Epstein et al.
  • J Am Dent Assoc, Vol 138, No 12, 1555-1562.

Background:
Early diagnosis of oral premalignant lesions (OPLs) and oral squamous cell carcinoma facilitates treatment with less aggressive approaches and results in a better prognosis. The authors conducted a study to identify current practices in the diagnosis and management of these oral lesions by oral medicine professionals.

Methods:
The authors sent a questionnaire to 176 diplomates of the American Board of Oral Medicine and asked them to complete the questionnaires and return them by mail.

Results:
The initial clinical approach taken by most of the responders included visual examination, elimination of possible local causes and two-week follow-up. Adjuvant clinical tests included toluidine blue, oral brush biopsy and exfoliative cytology. If there was no clinical improvement after two weeks, most responders recommended that a biopsy be performed. Induration, red component, nonhomogeneous surface and ulceration were characteristics of lesions that increased the responders’ decisions to perform a biopsy. Lesion symptoms and location also contributed to their decisions to perform a biopsy. Follow-up more frequently than twice a year was recommended for red lesions, lesions with histologically confirmed dysplasia or both. Most clinicians recommend a biopsy during follow-up of an OPL whenever the lesion changes in appearance.

Conclusions:
The findings of this survey may provide background for initial guidelines to be used by oral practitioners to diagnose and manage OPL. Clinicians’ awareness of the complexity of OPL diagnosis and management is important, and referral to an experienced provider is recommended.

Authors:
Joel B. Epstein, DMD, MSD, FRCD(C), FDSRCSE, Meir Gorsky, DMD, Dena Fischer, DDS, MSD, MS, Anurag Gupta, BDS, MPH, Matthew Epstein, BSc and Sharon Elad, DMD, MSc

December, 2007|Archive|

New Radiation Treatment is Better for Throat Cancer Patients, Research Shows

  • 12/1/2007
  • Denver, CO
  • Regina Sass
  • People’sMediaCompany (www.associatedcontent.com)

Researchers at the University of Iowa Department of Radiation Oncology and Department of Otolaryngology – Head and Neck Surgery are recommending new, intensity-modulated radiation therapy for treating a variety of throat cancers, saying that it can improve the patient’s quality of life better than the conventional radiation therapy.

Oropharyngeal – throat – cancer, originates in the part of the throat – oropharynx.- just after the mouth. It can also be in the tonsils and th back of the tongue. Squamous cell carcinomas, which originate in from the cells that make up the lining of the mouth and throat make up in excess of 90% of oropharyngeal cancers.

Lately, the cancer has been occurring in a growing number of younger patients as well as in nonsmokers

The aim of the study was to get a comparison of the health related quality of life in the patients who were treated with the conventional CRT and the new IMRT.

With the CRT, two or three beams of radiation are aimed at the tumor, but the surrounding tissues and organs such as
the oral cavity and salivary glands, receive that same high dose as the tumor. In some of the patients, the salivary glands are totally destroyed and patients can also develop severe dryness in the mouth and a poor quality of life.

On the other hand, the IMRT uses multiple radiation beams and they are broken down into what they call beamlets. This gives the radiation oncologists the ability to target the radiation to the tumor much more accurately so that the surrounding healthy structures do not get damaged.

For the study, they chose 53 patients who were in the database of the Outcomes Assessment Project funded by
National Institutes of Health, which is a study that was begun more than 10 years ago. Its purpose is to document the outcomes from patients with cancers of the upper aerodigestive tract. They split the patients into two groups, 26 received the IMRT and 27 the CRT.

They monitored the patients at the 3, 6 and 12 month times after the end of the treatment. The patients also filled out surveys that they could determine their quality of life by measuring any changes in their physical appearance, changes in how they interact with other people and how their eating and speech were affected.

At the 12 month level, the IMRT group showed a better quality of life in all of the areas. The biggest difference was in eating. Those in the IMRT group had improved eating ability at the 6 month level and they continued to improve. In the CRT group, their ability was still deteriorating at the 6 month level and they only showed minimal improvement at 12 months

The lead researcher is Min Yao, M.D., Ph.D., an associate professor at the University of Texas Southwestern Medical School Department of Radiation Oncology.

December, 2007|Archive|

As cigarette sales dip, new products raise concerns

  • 12/1/2007
  • web-based article
  • Wendy Koch
  • USA Today (www.usatoday.com)

The Marlboro Man, that cigarette-smoking icon of the tobacco industry, is more than a half-century old.
If he were conceived today, there might not be just a cigarette dangling from his mouth. He might also have, tucked into his pocket, a cellphone-size container holding a dozen pouches of snus

Snus?

It rhymes with “goose,” (cynics might say “noose”), and is a Swedish type of smokeless tobacco that’s not your grandfather’s dip or chew. Snus comes in teabag-like pouches that a user sticks between the upper lip and gum, leaves there for up to 30 minutes and discards without spitting.

As no-smoking laws sweep the nation and cigarette sales continue to fall, Big Tobacco is alarming the public health community by devising other ways to try to make tobacco appealing. With smokeless products representing the only booming part of the U.S. tobacco market, snus is an effort to boost sales with a product that — unlike most smokeless ones — doesn’t require users to spit out the residue.

Snus also represents something more: an attempt to move smokeless tobacco beyond stereotypical users such as baseball players and rodeo cowboys, and into offices or restaurants where people want a nicotine fix but can’t light up.

“This is a growth strategy for us,” says Bill Phelps, spokesman for Philip Morris USA, the nation’s biggest tobacco company and maker of Marlboro, the top-selling cigarette. In Dallas this month, Philip Morris is launching its first smokeless product with a cigarette brand name: Marlboro Snus.

R.J. Reynolds, second in U.S. tobacco sales, is expanding tests of its Camel Snus from two cities to eight, which will include Dallas this month. Its ads have a “pleasure for wherever” tagline and a playful tone. Its “abridged guide to snusing” says, “Picture yourself stuck in the center seat 44B of an airplane: You can mope, or you can Snus.”

Public health advocates aren’t smiling.

Although some say smokeless tobacco poses fewer health risks than cigarettes, they note that it has been linked to various types of cancer and warn against using any tobacco product.

“What on the surface looks promising could turn out to be a public health disaster,” says Gregory Connolly, director of tobacco control research at Harvard School of Public Health.

He says the products are still addictive, and unless the Food and Drug Administration can regulate tobacco, consumers won’t know what’s truly in snus. A bill that would give the FDA such authority passed a U.S. Senate panel Wednesday and is gaining co-sponsors in the U.S. House.

Under laws in every state, snus and other tobacco products may not be sold to anyone younger than 18. But many health advocates see the new smokeless alternatives as an attempt to create a new generation of tobacco users.

Snus will “increase the number of people who use tobacco,” says Matthew Myers, president of the Campaign for Tobacco-Free Kids. “It’s market protection. This way, the big companies win no matter what tobacco products people use.”

Link to article: http://www.usatoday.com/news/nation/2007-08-06-snus_n.htm

December, 2007|Archive|

Actress Colleen Zenk Pinter Partners with the Oral Cancer Foundation to Raise Public Awareness

Two time Emmy nominated actress Colleen Zenk Pinter, best known for her long running role as Barbara Ryan on CBS’s As the World Turns, has teamed up with the Oral Cancer Foundation to share the story of her battle against oral cancer, and raise public awareness of a disease which kills more Americans each year than more commonly known cancers.

Zenk Pinter’s first stop was CBS’s The Early Show. In an interview with co-anchor Hannah Storm, Zenk Pinter revealed how a seemingly stubborn canker sore turned out to be a stage-two malignant oral cancer, requiring several surgeries to reconstruct her tongue, and months of radiation treatments. Zenk Pinter explained to Storm that she believes that her cancer was caused by the human papillomavirus. “I had absolutely none of the historic risk factors for this cancer, I never used tobacco and only drank socially,” she said, referring to the two other common causes of the disease.

“In fact, young Americans who have none of the historic risk factors are the fastest growing segment of oral cancer patients in the country,” Brian Hill, executive director of the Oral Cancer Foundation says, “and we believe the culprit behind the surge in cases is HPV16, the same virus that causes cervical cancer.”

Dr. Mark Lingen, Professor of Pathology at the University of Chicago School of Medicine says, “Colleen was very typical of most Americans in their lack of knowledge of oral cancer. Awareness and routine screening is particularly important, since early discovery is directly correlated to positive outcomes from treatment.” HPV is the most common sexually transmitted disease in the United States. At least 50 percent of American adults will acquire the virus at some point in their lives. HPV16, one of the most destructive strains of the virus, was definitively linked to oral cancer in 2001. Research has also established that the virus, which can easily be transferred, may even be a more significant risk factor than tobacco in the younger portion of the population.

“Colleen is an amazing woman”, said Hill. “Even BEFORE she had begun her treatments for the cancer, she contacted me and wanted to become an advocate for early detection and increased awareness. She was clearly taken by surprise to have developed this cancer. Most people at that point in the process are only thinking of themselves, and getting through the really tough treatments successfully. Her willingness to talk publicly about her very personal and painful battle with oral cancer is certainly courageous, and the desire to help others is palpable when you speak with her. Her story and high profile celebrity as a well-known TV actress will have enormous impact educating the public about this deadly and disfiguring disease. This is one of the purest examples of altruistic, celebrity power being used to better other people’s lives. We are lucky to have this partnership with Colleen.”

Now cancer-free, Zenk Pinter urged viewers of The Early Show to get regular oral cancer screenings. “Your dentist should be doing an oral cancer exam at every visit,” Zenk Pinter said. “It’s a simple 5 minute, painless exam that may save your life.”

The Early Show was only the first of what is on the public awareness schedule for Zenk Pinter. A recent interview with Soap Opera Digest is already on the newsstands, and interviews with other magazines have been scheduled. In December she will film a TV Public Service Announcement on the need for early detection through annual screenings. OCF will distribute the PSA to TV stations across the country at the beginning of 2008.

About Colleen Zenk Pinter

Ms. Zenk Pinter has worked professionally since the age of nine as an actress. Besides her long time association with As the World Turns, in which she has appeared in over 250 episodes, Colleen made her Broadway debut in Bring Back Birdie. Her film debut was in John Huston’s adaptation of Annie. Her benevolent and philanthropic association with health causes is not new, and for decades she has donated time to work with the Easter Seals, the March of Dimes, the Cystic Fibrosis Foundation and Bread to Roses, one of the first AIDS hospice programs. For more information about Colleen’s background, go to http://www.astheworldturns.net

The Oral Cancer Foundation, founded in 2000, is a national non-profit charity based in California. The foundation advocates for better public understanding of the disease and engages the medical and dental communities to be more involved in early detection. The foundation maintains a Web site with information for patients, the public, and health care providers at www.oralcancerfoundation.org. It is supported through tax-deductible public donations which can be made at http://www.oralcancerfoundation.org/membership/membership.htm.

November, 2007|OCF In The News|

Speaking Out

  • 11/28/2007
  • web-based article
  • Jennifer Lenhart
  • www.soapoperadigest.com

Long running TV show As the World Turn’s Colleen Zenk Pinter (character Barbara Ryan) spoke about her battle with tongue cancer in Digest’s 11/27 issue, but her main goal is to encourage everyone to get screened. It’s a quick, completely painless procedure. “You should demand a cancer screening from your denist,” she advises. “They’ll look in your mouth and feel down inside your jaw bone, outside and inside, upper and lower, they’ll look at your tongue and throat.” Here, she talks more about her initial diagnosis, and when she first decided to share her story.

Soap Opera Digest: How did this all begin?
Colleen Zenk Pinter: I first noticed it last summer, so it’s been over a year now. [I constantly had] canker sores coming and going last summer into last fall. They finally stopped going away and started getting larger — you know how painful one is, these were multiplying. I said, “This isn’t right,” and that’s when I called my physician to get my yearly, thinking I could get in right away, forgetting that it takes a while to book something like that. I called the second week of November and he couldn’t get me in until the first week of January. I had actually talked to Eldo [Ray Estes, ATWT’s key makeup artist] at work about it. I had shown him and said, ‘I’m dealing with this nasty thing that won’t go away.’ So I went in and saw my doctor, got my physical. All of my numbers, my blood work, my cholesterol, my iron, everything was in great shape. I was a really healthy 54-year-old who has boundless energy. I overbook myself all the time, as my mother tells me. I said to the doctor, “Take a look at this.” And he said, “I don’t like it. You’re going to go see a maxillofacial specialist tomorrow.” … [The specialist] said, “I think you have a combination of a fungal and bacterial infection, so let’s treat you for that.” It was an antibiotic, a big bottle of orange medicine. And it started working and it got better. I would go back and see him every single week for five weeks. And then it stopped working. [What was left was the tumor.] Usually, you don’t know what’s going on inside of your mouth. By the time I went into surgery, if I stuck my tongue out, you could see the right side was about twice as big as the left, and the tumor went way to the back. You could feel the entire thing. But who goes around feeling their tongue?

Digest: What did it feel like?
Pinter: Hard, and it was elongated and fat.

Digest: Is that why the sores kept coming and going?
Pinter: They don’t know.

Digest: But you hadn’t really felt it before.
Pinter: I didn’t actually feel my tongue until after I got the diagnosis. So at that point, he said, “I think we need to do a biopsy.” So he put me under a general anesthetic in the office. Mark [Pinter, her husband, ex-Grant, AW et al] was there with me, and then he had to go to California. Unfortunately, he was going to be gone for [daughter] Georgia’s 14th birthday, but [daughter] Kelsey came home and I said, “I want you to come with me to see [the doctor]. I love him; I think he’s a fabulous doctor.” As I was walking out of the house, the phone rang. I let it go through to voicemail; it was a nurse [at the cancer center] saying, “We just wanted to let you know that the doctor has scheduled you for an appointment on Wednesday,” which was two days later. I thought, “Okay.” I already knew at that point. So when we got to the office, the doctor was there and the room was full of all of his nurses, who I knew really well at that point … I won’t go into all of that because it was so wild and wacky the next couple of days, but when all of a sudden you get a diagnosis like this and they say, “Don’t go home and get on the Internet,” you go home and get on the Internet. I knew it was cancer. I knew it was Stage 2. And that was pretty much all I knew … Luckily, one of the first sites I found was www.oralcancerfoundation.org. The week before I went into my first surgery was when I contacted Brian Hill of the Oral Cancer Foundation. I left him a very lengthy voicemail, not thinking that this man who was the head of the foundation would call me back. At that point, I didn’t know he was a Stage 4 cancer survivor. But he called back and thus began our association. I said, “I want to do something. Tell me what I can do.” He said, “That’s great, but you’re way ahead of yourself.” I said the same thing to my group [of doctors] at Yale and they said, “You’ve got to get through and then figure out if you want to do something.” So it was when I got back from doing [Stephen Sondheim’s] Follies [in Sullivan, IL] that I decided to speak about it.

Digest: What has the response been like?
Pinter: The outpouring of understanding and love and encouragement that I have felt, from not just the fans but people who have found out about this and have had family members or they themselves have gone through it, the support has been overwhelming. It’s all, “Thank you for getting it out there. Thank you for saying something, speaking up.” That’s all it’s about.

November, 2007|OCF In The News|

CT Scans Raise Cancer Risk

  • 11/28/2007
  • web-based article
  • Marilynn Marchione
  • apnews.myway.com

Millions of Americans, especially children, are needlessly getting dangerous radiation from “super X-rays” that raise the risk of cancer and are increasingly used to diagnose medical problems, a new report warns.

In a few decades, as many as 2 percent of all cancers in the United States might be due to radiation from CT scans given now, according to the authors of the report.

Some experts say that estimate is overly alarming. But they agree with the need to curb these tests particularly in children, who are more susceptible to radiation and more likely to develop cancer from it.

“There are some serious concerns about the methodology used,” but the authors “have brought to attention some real serious potential public health issues,” said Dr. Arl Van Moore, head of the American College of Radiology’s board of chancellors.

The risk from a single CT, or computed tomography, scan to an individual is small. But “we are very concerned about the built-up public health risk over a long period of time,” said Eric J. Hall, who wrote the report with fellow Columbia University medical physicist David J. Brenner.

It was published in Thursday’s New England Journal of Medicine and paid for by federal grants.

The average American’s total radiation exposure has nearly doubled since 1980, largely because of CT scans. Medical radiation now accounts for more than half of the population’s total exposure; it used to be just one-sixth, and the top source was the normal background rate in the environment, from things like radon in soil and cosmic energy from the sun.

A previous study by the same scientists in 2001 led the federal Food and Drug Administration to recommend ways to limit scans and risks in children.

But CT use continued to soar. About 62 million scans were done in the U.S. last year, up from 3 million in 1980. More than 4 million were in children.

Since previous studies suggest that a third of all diagnostic tests are unnecessary, that means that 20 million adults and more than 1 million children getting CT scans are needlessly being put at risk, Brenner and Hall write.

Ultrasound and MRI, or magnetic resonance imaging, scans often are safer options that do not expose people to radiation, they contend.

CT scans became popular because they offer a quick, relatively cheap and painless way to get 3D pictures so detailed they give an almost surgical view into the body. Doctors use them to evaluate trauma, belly pain, seizures, chronic headaches, kidney stones and other woes, especially in busy emergency rooms. In kids, they are used to diagnose or rule out appendicitis.

But they put out a lot of radiation. A CT scan of the chest involves 10 to 15 millisieverts (a measure of dose) versus 0.01 to 0.15 for a regular chest X-ray, 3 for a mammogram and a mere 0.005 for a dental X-ray.

The dose depends on the type of machine and the person – obese people require more radiation than slim ones – and the risk accumulates over a lifetime.

“Medical care in this country is naturally so fragmented. Any one doctor is not going to be aware of the fact that a particular patient has had three or four CT scans at some point in the past,” said Dr. Michael Lauer, prevention chief at the National Heart, Lung and Blood Institute.

People with chronic problems like kidney stones are likely to get too many scans, said Dr. Fred Mettler, radiology chief in the New Mexico Veterans Administration health care system.

“I’ve seen people who are 30 years old who have had at least 18 scans done,” he said.

That puts them at risk of developing radiation-induced cancer, Brenner and Hall said. They base this on studies of thousands of Japanese atomic bomb survivors who had excess cancer risk after exposures of 50 to 150 millisieverts – the equivalent of several big CT scans.

“That’s very controversial. There’s a large portion of the medical physics community that would disagree with that” comparison, said Richard Morin, a medical physicist at the Mayo Clinic in Jacksonville, Fla.However, others defended the data, which has been widely cited in other radiation studies.

“It’s the best evidence we’ve got” on cancer risks, Lauer said.

Dr. Robert Smith, the American Cancer Society’s director of screening, said the authors’ estimate that 2 percent of future cancers may be due to CT scans “seems high.” But since cancers take 10 to 20 years to develop, “the ability to even observe that kind of an increase is going to be very difficult,” he said.

The authors stressed that they were not trying to scare people who need CT scans away from having them. In most cases, the benefits exceed the risks, especially for diagnostic scans.

However, using the scans to screen people with no symptoms of illness – like screening smokers for signs of lung cancer – has not been shown to save lives and is not currently recommended.

Many groups also condemn whole-body scans, often peddled by private practitioners in shopping centers as peace of mind to the worried well. Many of these centers are not accredited by the College of Radiology; only a third of all places that do CT scans in the U.S. are, although insurers are starting to require it for reimbursement, Moore said.

Many CT centers also are set up for adults and rarely image children, who need adjustments to limit dose and radiation risk, said Dr. Alan Brody, a radiologist at Cincinnati Children’s Hospital Medical Center who wrote a report on the topic. He said parents should seek a center that often handles children.

Both doctors and patients need to be more aware of radiation risks and discuss them openly, Brenner and Hall said.

“We were astonished to find, when we were researching materials for this paper, how many doctors, particularly emergency room physicians, really had no idea of the magnitude of the doses or the potential risks that were involved,” Hall said.

Other studies found the opposite problem: Three out of 10 parents in one study insisted on CT scans instead of observing the child’s condition for awhile even after they were told of the radiation risk, Brody said.

“This is what our patients want,” and they expect fast answers from doctors, he said.

The pressure is greatest for ER doctors who “are in a bind … they have all these patients stacked up” and need to make quick decisions, Mettler said.

Future generations of devices using less radiation should help alleviate the concern, but these mostly are directed at the emerging field of heart scans, Lauer said.

“When we order a CT scan it just doesn’t seem like such a big deal” but it should be, he said. “The threshold for ordering these tests is low and it’s getting lower and lower over time, which means that the risks become potentially all that more important.”

November, 2007|Archive|