
We Are Giving Ourselves Cancer - uladzislau
http://nytimes.com/2014/01/31/opinion/we-are-giving-ourselves-cancer.html?from=mostemailed
======
petersellers
The article's first sentence annoys me right off the bat:

"Despite great strides in prevention and treatment, cancer rates remain
stubbornly high and may soon surpass heart disease as the leading cause of
death in the United States."

This seems to be implying that cancer death rates are growing and will soon
"surpass" those of heart disease. While the article is technically correct,
this is due to the fact that deaths per year from heart disease have been
going down in the US since 1975 (see here:
[http://www.heart.org/idc/groups/heart-
public/@wcm/@sop/@smd/...](http://www.heart.org/idc/groups/heart-
public/@wcm/@sop/@smd/documents/downloadable/ucm_449847.pdf))

It's irritating because the article's premise is flawed. It also gives no
statistical data to back the claim that cancer rates are increasing.

~~~
ChuckMcM
Because it wants to scare you, not reassure you. If it had started, "We've
been so successful in tracking down and treating the things that lead to heart
disease, it may soon drop to second place leaving Cancer as the #1 cause of
death." Then you would be all happy that you weren't going to die of a heart
attack and realize that your risk of dying from cancer hadn't changed
(actually its been going down as the cohort of major smokers leave the
population). But who wants to feel good about this stuff really? :-)

~~~
dvanduzer
There's plenty of cognitive dissonance now that the stuff that kills us
anymore is the stuff we understand the least. Actuarial tables aren't
something we can reason about intuitively.

I was shocked to learn that an nMRI (where the nuclear "n" is usually silent)
doesn't involve radioactivity. Such careful PR to avoid confusion about
electromagnetic radiation, and it didn't even work?

------
DenisM
>A single CT scan exposes a patient to the amount of radiation that
epidemiologic evidence shows can be cancer-causing

That does not look right to me. A single CT scan is 2-7 millisieverts, and
exposures under 13 can not be linked to health effects - look for UNSCEAR in
[http://en.m.wikipedia.org/wiki/Sievert](http://en.m.wikipedia.org/wiki/Sievert)

If you do the math by ICRP formulae, you end up with increase chance of cancer
of 1 in 2600 over the next 20 years from a single 7ms CT scan today. This
compares favorably with "natural" risk that is 1 in 10 without any extra
exposure above background radiation.

Now if you do a scan every year for the next 20 years your chances go up to 1
in 130. So there is something to worry about, but article overstates the
cause.

~~~
yetanotherphd
>If you do the math by ICRP formulae, you end up with increase chance of
cancer of 1 in 2600 over the next 20 years from a single 7ms CT scan today.
This compares favorably with "natural" risk that is 1 in 10 without any extra
exposure above background radiation.

But that is a meaningless comparison. The doctor should be comparing this
additional risk, to the benefit of the scan.

The "natural" risk of developing cancer is totally irrelevant to the cost-
benefit analysis.

~~~
DenisM
I see your point.

I wonder though if there should be a cutoff somewhere, below which you stop
caring? I used background cancer rates as an anchor to judge if the cutoff has
been reached, without getting specific about benefits of treatment in each
particular case. Would you suggest another cutoff level that is broadly
applicable?

~~~
yetanotherphd
I think the only comparison that makes sense is the benefit from the scan.

So if you are certain that the benefit of the scan is, no matter what the
particular case, going to be worth much more than a 1/1000 chance of getting
cancer, then that is a reason to ignore the risk.

------
nostromo
This goes beyond the medical field. ProPublica did a story about how X-rays
are becoming more common in law-enforcement and border security as well.

[http://www.propublica.org/article/drive-by-scanning-
official...](http://www.propublica.org/article/drive-by-scanning-officials-
expand-use-and-dose-of-radiation-for-security-s)

~~~
tlrobinson
Is there a relatively inexpensive portable Geiger counter or something that
can measure this type of radiation?

~~~
jorgem
[http://www.amazon.com/RADStickerTM-radiation-exposure-
determ...](http://www.amazon.com/RADStickerTM-radiation-exposure-determining-
dosimeter/dp/B004VJ06CI/ref=sr_1_1?ie=UTF8&qid=1391321366&sr=8-1&keywords=dosimeter)

~~~
kaybe
Or you could just get an app (and some black tape), depending on the energy
range you want to look at:

[http://www.xinexus.ch/nuclear-radiation-
dosimeter/index.html](http://www.xinexus.ch/nuclear-radiation-
dosimeter/index.html)

edit: I think I got the wrong thing there.. better go for this:

[http://www.hotray-info.de/html/radioactivity.html](http://www.hotray-
info.de/html/radioactivity.html)

------
refurb
I have no doubt that patients are getting exposed to more radiation via
imaging than they need to.

However, every decision in medicine is (or should be) a risk-vs-benefit
analysis. Cancer is not the only thing you can die from. If you suffer a head
injury and end up in the ER and get a CT scan, you may increase your long-term
risk of cancer, but you are also _drastically_ reducing the risk of dying from
a brain hemorrhage that couldn't be identified by any other method.

~~~
skue
Of course, no one would dispute ordering a CT for a trauma patient if the
presentation warrants.

But the article was talking about the increase in CT usage over the past 20
years. That's largely been driven (in the US) by misaligned incentives that
reimburse procedures at much higher rates that clinical decision making. Put
simply, the person who owns the CT machine makes much more than the doctor who
interprets the results. And so we have had a blossoming of imaging centers,
and CT machines have moved into outpatient cardiology and even family care
practices.

One of the major goals of Obamacare is addressing these misaligned incentives
and shifting to a model where providers are paid to keep people healthy
(outcome driven) rather than on volume (fee for service).

Another issue has been the difficulty of sharing/accessing existing imaging
data, so tests are just repeated to save time (rather that save cost or
adequately balance safety). Our long, painful journey to electronic record
standardization should also help with that.

~~~
carbocation
CT is also simply more available, so it's an option. In the past, not so much.

------
adrr
Cancers rates are have been on the decline or remaining steady not rising.
Look at the stats for the most common types of cancer.

[http://seer.cancer.gov/statfacts/html/prost.html](http://seer.cancer.gov/statfacts/html/prost.html)

[http://seer.cancer.gov/statfacts/html/colorect.html](http://seer.cancer.gov/statfacts/html/colorect.html)

[http://seer.cancer.gov/statfacts/html/breast.html](http://seer.cancer.gov/statfacts/html/breast.html)

[http://seer.cancer.gov/statfacts/html/lungb.html](http://seer.cancer.gov/statfacts/html/lungb.html)

~~~
scotty79
I wonder how discouraging people from air travel influences cancer rates...

------
beloch
CT Scan doses vary wildly depending on the type of X-ray (chest, head, limb,
etc.), the size of the person, and a lot of other things. The bigger the
cross-section of the thing you put in a scanner, the greater the exposure. CT
machines themselves also vary considerably. Newer machines are often more
sensitive and employ better imaging software, so they can do their job while
delivering a much smaller dose. Anyone who quotes a solid number is probably
using one that's absolute worst-case, which probably means a chest scan on a
fat dude with a CT machine that's been around as long as disco music.

Personally, I like to think of medical imaging in terms of how long I'd have
to work as a flight-attendant to get the same dose. When you fly at high
altitudes (as most passenger jets do) there is less atmosphere to block cosmic
radiation, which is the source of background radiation that we're exposed to
every day. You get a higher dose of radiation at high altitudes amounting to a
few tens of microsievert's for a decently long flight. Medical X-Rays that
consist of a single photo are approximately in the same ball-park as an
intercontinental flight or two, or working as a flight-attendant for a day or
so. CT scans are in the ballpark of several months working as a flight-
attendant. It sounds bad at first, but flight-attendants aren't known to have
a massively increased rate of cancer after doing the job for _decades_.

In general, people fear radiation to an extent that is out of proportion with
reality. To add more perspective, the background radiation in your living room
will add up to a CT scan, most likely, in less than a year (unless you live in
very deep mine). You can marginally improve your odds of getting cancer by
avoiding medical scans, but only at the cost of massively increasing your odds
of dying from something those scans might have helped diagnose. It's not an
intelligent trade-off. Yes, unnecessary CT scans are bad, but not as bad as
the article claims. The greatest cost of an unnecessary CT scan is probably to
those who don't get scanned due to high demand on the machine. This article,
by stoking irrational fears of medical imaging, is more likely to harm people
than help them.

Note: Medical imaging is generally not done very often, is tracked, and is
usually performed by trained technicians with quality apparatus. The same is
not true of security X-Ray scans, which people can be subjected to much more
frequently, are frequently performed by the near-unemployable, and use
machines that are not designed with the primary goal of helping those it
scans. The U.S. is also starting to use truck-based scanners to scan parked
vehicles and people on public streets. You may be scanned by these not only
without consent, but without _knowledge_. I do find this to be objectionable.

~~~
hawkharris
While your comment as a whole is thoughtful and well written, I'm surprised to
hear you say, "Medical imaging is not done very often..."

Medical imaging is commonly overused, and its overuse is recognized as being
one of the leading causes of certain types of cancer. For example, the
original story explains...

"In a 2011 report sponsored by Susan G. Komen, the Institute of Medicine
concluded that radiation from medical imaging, and hormone therapy, the use of
which has substantially declined in the last decade, were the leading
environmental causes of breast cancer, and advised that women reduce their
exposure to unnecessary CT scans." (The substantial decline refers to hormonal
therapy, not imaging.)

~~~
IsTom
Perhaps it varies wildly between countries. I've never heard of anyone I know
having a CT scan, but I know of 3 MRI scans.

~~~
gus_massa
MRI is very different from CT. CT use X-rays, which is an ionizing radiation.
MRI uses a very strong magnetic field, and as far as we know it doesn’t
increase the cancer rates.

The final images are quite similar in appearance (semi transparent films with
a black background), but the underlying process is very different.

------
sjtrny
"We are giving ourselves cancer by living long enough to develop it"

is what the title should have said. This article is the worst form of opinion.

~~~
sgustard
Agree, and it's not opinion, it's scare-mongering linkbait. Ridiculous to see
that along with no actionable data from NYT. I'm giving myself a stroke just
thinking about it.

------
pessimism
Any people here who go to the dentist?

    
    
       Specifically, the American Dental Association's 
       guidelines for heathy persons suggest that
       
       * children receive 1 x-ray every 1-2 years,
       * teens every 1.5-3 years,
       * and adults every 2-3 years.
    

~
[http://www.medicalnewstoday.com/releases/243952.php](http://www.medicalnewstoday.com/releases/243952.php)

I was personally very surprised and alarmed by this.

~~~
DenisM
Before getting alarmed consider doing the math to assign numerical value to
level of danger. Wikipedia article on Sievert has the formulas for it, as well
as benchmark values to judge the outcome.

If you don't want to do the math, consider this handy chart:
[http://xkcd.com/radiation/](http://xkcd.com/radiation/)

~~~
cma
Why does a kid who hasn't lost his baby-teeth need dental x-rays?

------
tokenadult
The xkcd chart on dosages of ionizing radiation

[http://xkcd.com/radiation/](http://xkcd.com/radiation/)

is a good introduction to the orders of magnitude differences in exposures
from different kinds of sources.

~~~
hrjet
It would have been more helpful if that chart didn't mix the units of time.

------
97s
I am a surviving AML patient, relapsed once and had a stim cell donor. I have
had over 50-60 CT scans and I have one or two a month to monitor my lungs for
fluids. This article makes me chuckle cause who knows what it's doing to me,
but without the CT scans to spot pneumonia and other infections in my lungs I
would probably have died already.

~~~
mbreese
Congrats on surviving AML.

I have a few oncologist friends. I think that their point of view is that once
you go to see them, getting a CT or 50 is the least of your problems. So, if
they even _think_ there is something wrong, you're getting a CT. The risk of
having a problem _now_ is much worse than the remote risk of something else
going wrong in the future. If you survive this bout, who cares about the extra
radiation exposure.

Being able to worry about that later is a good problem to have.

~~~
97s
That's exactly how I feel. CT sure sign me up. Ive had so much chemo therapy
and radiation xrays and scans that I am sure my lifespan is shortened a lot.
However I am alive 6 more years than I should have been, and I have a son and
a wife that I would have never experienced.

------
dnautics
Big elephant in the room: Pre-test ban atmospheric nuclear tests.

Of course, there's nothing anyone can do about it. The somatic damage period
is probably more or less over, but we are transitioning through the genetic
damage period.

~~~
throwaway_yy2Di
Squeaky mouse in the room: the actual numbers.

[https://en.wikipedia.org/wiki/Background_radiation](https://en.wikipedia.org/wiki/Background_radiation)

Natural background: 2.40 mSv/year (world average)

Atmospheric testing: "peak of 0.11 mSv in 1963"

~~~
dnautics
Isotopes of specific atoms have a different biochemical targetting and effect
than EM radiation. Iodine is concentrated in the thyroid, strontium makes its
way to the bone (close to hematopoetic stem cells), etc.

------
rdl
When I worked with radiologists (at a PACS vendor, mainly selling to the
military and the federal prisons), the radiologists and staff _were_
exercising due care about minimizing radiation exposure from CTs.

Personally, I don't care about regular x-rays, particularly digital ones, for
any reasonable medical use. I get one every year or two as part of a checkup.

CT and C-arm fluoroscopy scare me, as an educated person who isn't a doctor
but knows more than 99% of people about radiation safety, and I'd want there
to be a clear clinical need and decision supported by them. Which is the
standard I saw applied. (I never actually saw a c-arm procedure) In extreme
trauma you might err on the side of a CT in 1/100 cases. but that's not a big
deal.

~~~
a8da6b0c91d
Apparently loads of dentists lost fingers and hands to cancer and bone
degeneration before they figured out not to hold the x-ray film themselves.
Now they have the patient hold it. It just drives home that the stuff is not
harmless.

~~~
gus_massa
Let’s analyze the worst case scenario: 50 weeks/year * 5 days/week * 8
hours/day * 2 patients/hour = 4000 patients/year

So your finger would get 4000 “dental” x-ay of ~5uSv (u=micro), that is 20mSv.
For comparison, the radiation worker yearly dose limit is 50mSv, but the 50mSv
are distributed to all the body, and you get the 20mSv in your finger. Doesn’t
sound good.

The problem is the repetition. Taking 4000 dental x-rays in a year is not a
good idea. (I’m not sure if someone proved that it’s dangerous, but don’t try
this just in case.) This is also the reason why x-rays technicians hide behind
a shield while taking the x-ray.

* Nobody claims that x-rays are not dangerous. The claim is that the risk is minimal under reasonable use and in some circumstance (for example an accident) the benefits are much bigger than the risks.

* And the Linear No-Threshold model is mostly an upper bound, the risk of small radiation dose is perhaps smaller than what is extrapolated from big radiation doses.

For example, suppose that 4000000 patients take one dental x-ray and 1000
dentist take 4000 dental x-rays each one. In which group will be bigger the
increase of the cancer total number? The Linear No-Threshold model says that
the expected number should be equal. But perhaps it’s smaller in the patients
group, because the body perhaps can deal better with a low number of problems
from radiation.

------
DenisM
A handy radiation-exposure chart:
[http://xkcd.com/radiation/](http://xkcd.com/radiation/)

It's the first thing I check with before looking for any details (which are
conveniently linked at the bottom, by the way).

------
cesarbs
What about MRIs? Don't they offer the same benefits of CT scans but without
all the radiation?

~~~
Someone
No. They have different strengste and weaknesses. Roughly, CT is for bones and
rough details of soft tissues, MRI for detailed views on soft tissue in
patients without metal implants. More nuanced views at [http://www.ct-scan-
info.com/mrivsctscan.html](http://www.ct-scan-info.com/mrivsctscan.html),
[http://www.diffen.com/difference/CT_Scan_vs_MRI](http://www.diffen.com/difference/CT_Scan_vs_MRI)
or [http://blog.radiology.ucsf.edu/neuroradiology/exploring-
the-...](http://blog.radiology.ucsf.edu/neuroradiology/exploring-the-brain-is-
ct-or-mri-better-for-brain-imaging/)

For the discussion at hand,
[http://en.wikipedia.org/wiki/Magnetic_resonance_imaging#MRI_...](http://en.wikipedia.org/wiki/Magnetic_resonance_imaging#MRI_versus_CT)
has some discussion.

------
Zigurd
Of course I'd rather get a CT scan sooner than an MRI later if I'm a serious
trauma patient. But CT scans are way over-used for procedures that are not
time-critical.

------
jleahy
People who receive CT scans have a higher rate of cancer. This seems like a
logical fallacy.

People who receive CT scans are more likely to get cancer. So CT scans must
cause cancer.

The alternate hypothesis are that people who are more likely to develop cancer
are more likely to have a CT scan. Given the tiny number involved here (in
absolute number of people who develop cancer after having a CT scan), is it
not possible that these people had a CT scan because of early symptoms of
cancer?

------
RK
Just FYI, there are a couple of initiatives in the medical imaging world to
reduce over exposure:

* [http://www.imagewisely.org/](http://www.imagewisely.org/)

* [http://www.imagegently.org/](http://www.imagegently.org/)

------
steveplace
>One in 10 Americans undergo a CT scan every year, and many of them get more
than one.

For what?

~~~
scotty79
For back pain? More than half of the people at some point in life develop some
for back pain. It's scary so if you can afford a scan you get it. Of course
there's nothing wrong and the pain goes away by itself in following months,
usually after switching chair in which you spend most of your waking hours.

~~~
DanBC
I can't imagine someone in the UK getting scans for lower-back back pain
unless there was some clinical need for it.

The advice for most people would tend to be "lose weight, get exercise, check
your beds and chairs; and carefully take paracetamol for the pain".

------
fredgrott
Actually at least in the USA there are geographic portions of the USA where
radon gases via what the house foundation was built on are more of a threat
than tracked medical imaging as obviously if the house is not tested than we
have no way of determining whether radon gas is a threat.

EPA map of radon gas zones, Zone 3 is the high risk level:
[http://www.epa.gov/radon/pdfs/zonemapcolor.pdf](http://www.epa.gov/radon/pdfs/zonemapcolor.pdf)

and no sarcastic comments about it also being the bible belt please..:)

------
md9999
This article does not represent current state of knowledge in this field, and
makes many misleading statements. I have presented a line-by-line criticism of
the article in my blog which is available at: [http://are-we-really-giving-
ourselves-cancer.blogspot.com/](http://are-we-really-giving-ourselves-
cancer.blogspot.com/)

CT scans are safe, and the present concerns regarding radiation dose from CT
scans are not justified by any evidence.

------
mdoss99
This article does not represent current state of knowledge in this field, and
makes many misleading statements. I have presented a line-by-line criticism of
the article in my blog which is available at:

[http://are-we-really-giving-ourselves-cancer.blogspot.com/](http://are-we-
really-giving-ourselves-cancer.blogspot.com/)

CT scans are safe, and the present concerns regarding radiation dose from CT
scans are not justified by any evidence.

------
mathgeek
I liked the part about them causing "excess deaths." It's good to know your
chance of dying is lower if you avoid CT scans...

~~~
DanBC
People are harmed when they get unnecessary CT scans. Not from the CT scanning
but from the unneeded treatment they get after that.

------
smalldaddy
The article misses a very important point.

People are living longer because of better heart care (lower death rates at a
given age from heart disease). All else being equal, this means people are
living longer, which in turn means they are at increased risk of getting
cancer.

The CT scan impact is small in comparison with this fact.

------
ryanmarsh
Ok fine, except that cancer is well... complicated.
[http://www.phdcomics.com/comics/archive.php?comicid=1162](http://www.phdcomics.com/comics/archive.php?comicid=1162)

------
gadr90
As a person who had two minor head injuries and took a CT after each one (to
find nothing, thankfully) in the last 6 months...

I find this rather disturbing.

~~~
ivanca
I took more than 20 in a couple of months (ordered by myself) after doctors
couldn't find anything concrete (later on the current diagnostic is
"fybromialgia" and the symptoms remain nearly 2 years later). I was aware of
cancer danger but I needed to find some treatment before ending completely
mad.

~~~
bloopletech
You may be interested in
[http://www.intidyn.com/Newsroom/article-0009.html](http://www.intidyn.com/Newsroom/article-0009.html)
\- the probable cause of fibro has been identified - which will be a huge boon
to the sufferers - including my girlfriend.

~~~
ivanca
Than you. I'm very up to the news on r/fibro (reddit) and I already read that
article but I'm glad you brought it up here. Since my diagnostic I'm also
trying to make my way to develop health tech that could help mitigate
(completely or partially) the pain and the other symptoms, so now I'm living
in the bay area instead of my own country.

------
cstefanovici
Why doesn't anyone mention that our diets are also culprits because they
weaken our immune systems. Diets full of fats cholesterol and cooked
vegetables do not have the required nutrients that we need day to day. This is
pretty eye opening:
[http://www.imdb.com/title/tt1528734/?ref_=nv_sr_1](http://www.imdb.com/title/tt1528734/?ref_=nv_sr_1)

------
NN88
I've had a theory that TSA workers will start reporting higher than average
cancer rates soon.

------
xpda
We are giving ourselves cancer when we spend time outdoors without sunscreen
or other protection.

------
blablabla123
I know several people that died of cancer, and as far as I know none of them
had a CT scan before it. In contrast, the one who was often scanned during his
illness, lived almost 10 years with cancer.

The article just says CT scan has higher radiation but other than that no hard
facts are presented. Looks like the NYT is writing research articles now...

------
nipponese
Not that we're doing anything to prevent it either... like, for example,
exercising.

------
leoc
leo'c Law of Medicine: You can get away with Absolutely Anything Whatsoever if
you characterise it as a medical treatment.

------
brosco45
Yup, and all the advise that helps are being voted down. So we shall enjoy you
people getting what you deserve.

------
squirejons
since the media is now exposing this secret there must have already been a
decline in CT scans, otherwise the media would never say a word about it. The
media never exposes a mainstream money making scam until the money has gone
out of it.

------
smegel
We also eat a lot more crap today.

~~~
mjhea0
blame monsanto, not our poor decisions

------
ypmagic
Stay around some carpet. The carpet absorbs the radiation from electronics
that you're all concerned about... I think so. Does carpet only absorb sound?

------
yeukhon
Let's simplify this. Industrial waste is everywhere. Old buildings are built
with cancerous materials and we are expose to all kinds of radiations and air
pollutions. We eat junk food, we don't exercise much. Kids are playing with
toys painted with lethal chemical substances. Second-hand smoking is always
present. We eat overfried food and we also sleep late.

So the story is clear and doesn't require some heavy scientific investigation.
We are risking.

~~~
judk
Sleeping late caused cancer now???

~~~
yeukhon
[http://132.248.16.1/pages/curso_ritmos/capitulo15/Davis.pdf](http://132.248.16.1/pages/curso_ritmos/capitulo15/Davis.pdf)
And weaken your body is one way to allow cancer to spread quicker.

[http://www.huffingtonpost.com/2013/08/27/stress-cancer-
gene-...](http://www.huffingtonpost.com/2013/08/27/stress-cancer-gene-immune-
system_n_3804917.html)

If you think cancer is all about radiation, you are wrong..

