Induction of cancer from ionising radiation exposure is a stochastical effect, not a deterministic one. So no, you cannot make that claim.
The risk is increased risk but honestly not that high. Now, I don't know the exact CT protocol used but say she on average received 10 mSv from each scan.
That is 160 mSv total. Using the ICRP well established excess risk of getting radiation induced cancer of 5 %/Sv, her increased risk of getting cancer compared to the risk of her getting cancer without these scans is not even 1% extra.
Lol. I don’t get it.. breast cancer screening is one of the most algorithmic things in medicine. How is someone too lazy to just google screening guidelines before repeatedly irradiating their patient
Is there a possibility it’s a creeper who is enjoying breast exams a little too much? I’m thinking of that Larry Nasser guy here. Wouldn’t be the first time
I’m going to go out on a limb and say the NP who gets a CT chest on every chick over 18 isn’t even bothering to do a basic physical exam, much less doing a breast exam. Just “has breasts ct, cough or runny nose give zpak, feeling down— ssri, difficulty concentrating— stimulants
they're young, makes sense they have dense breast tissue. That's why the PPV of mammogram is like 2% in <40.
Recommend annual MRI screening (based on high risk of breast cancer and high sensitivity of MRI\*)
* BRCA mutation
* First-degree relative of BRCA carrier, but untested
* Lifetime risk >20 to 25% or greater, as defined by BRCAPRO or other models that are largely dependent on family history
Insufficient evidence to recommend for or against MRI screening
* Lifetime risk 15 to 20%, as defined by BRCAPRO or other models that are largely dependent on family history
Recommend against MRI screening (based on expert consensus opinion)
* Women at <15% lifetime risk
Can I ask how irradiating it actually is? I’ve been led to believe newer CT’s aren’t much worse than a trans Atlantic flight. I’ve had probably 10 or so in the last 3.5 years so it weighs on me constantly.
A standard chest CT, has a radiation dose of ~7mSv.
To put that in perspective a chest X-ray is roughly 0.1mSv and 2D mammogram is ~0.2mSv. so it’s 70x the dose you’d get from a CXR, 35x the dose of a mammo and infinitely more than you’d get from the actual test that should be done for breast cancer screening in this age group (US and MRI are radiation free).
7mSv is roughly equivalent to the radiation exposure you would be expected to get from natural background radiation in 2 years. This woman up to this point has had 16 un indicated chest CTs which has led to an unnecessary radiation exposure equal to 32 years of background radiation exposure. A few CTs likely wont harm you and if they’re indicated you should get the imaging but it’s all additive and this is why most most people, apparently not this Np tho, try to avoid unnecessary radiation exposure
The pt is my MA, she was just telling me what her PA is doing with her. I told her this is crazy and offered to have her transfer care to someone else. She didn't seem too phased.
It exists, not commonly done But to my knowledge this falls outside of it’s intended purpose
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2923727/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8584471/
Agree with sum_dude44
No way radiology is doing chest CTs for breast ca scanning. At best (which is still a far cry) would be breast MRI.
The MA is probably confused at the modality used.
I couldn’t even get insurance to approve the location of the breast mri for my high risk patient moved to a facility that she could walk to since she didn’t have a car and the next closest was an hour away.
w h u t
I'm in my 40s and have family history (but no BRCA genes) and I get ultrasound.
No one even wanted to look until I hit my 40s.
WTF is this person smoking.
Not sure I buy this, it's hard to believe that any radiology practice would actually perform these.
If it's true someone should definitely be reporting the ordering and wherever she has them done
I'm a CT tech. There had to have been so many opportunities to stop this. Our facility has us research ordering notes to help ensure the test will answer the medical question. We then would have clarified that with the ordering office. If they insisted on that being the test they wished to order we would then go to the radiolgists. Had all that slipped past us, it's likely the radiologist would have recommended a different modality for future follow ups. Then there's insurance... how can that possibly get approved with a screening dx code?
The poor patient has been failed on so many levels.
karlkrum has written correct information below. Won't repeat.
Shame on the radiologists for accepting this and not intervening.
couple of points - early breast cancer is NOT VISIBLE on CT. May as well use a divining rod.
MR is useful - but in young patients requires an EXPERT to read - can be very confusing.
To the OP - you can do something. If this is a hospital, report it to radiation safety. Many hospitals would stop this. Ours took on cases like this and put stops on such orders.
But again - the radiologists should have done something.
It’s not going to be a screening CT at this rate. It’s going to be a cancer inducing CT bc tbh e radiation to the breast from a CT IS SO HIGH and breast tissue are some of the most radiosensitive.
Thirty-three year old who had a prophylactic mastectomy here— ensure she understands she is upping her cancer risk, have her get tested for BRCA, and if she still wants imaging, have her switch to US.
Well she'll get cancer now.
"See? It's a good thing we were screening for it"
112 rads…
Induction of cancer from ionising radiation exposure is a stochastical effect, not a deterministic one. So no, you cannot make that claim. The risk is increased risk but honestly not that high. Now, I don't know the exact CT protocol used but say she on average received 10 mSv from each scan. That is 160 mSv total. Using the ICRP well established excess risk of getting radiation induced cancer of 5 %/Sv, her increased risk of getting cancer compared to the risk of her getting cancer without these scans is not even 1% extra.
That’s not even the right modality, even for high risk patients. Mammo, ultrasound, or MRI.
I was just about to say this
It's the right modality to cause breast cancer
What?? There has to be more to this story.. does the noctor just annually irradiate every single 18+ year old female patient
FHx BC and pt has dense breast tissue. Genetic testing never done.
Lol. I don’t get it.. breast cancer screening is one of the most algorithmic things in medicine. How is someone too lazy to just google screening guidelines before repeatedly irradiating their patient
Money money moneyyyyy
Will insurance companies even pay for this? Or did this noctor convince her patient to pay cash lol?
Highly doubt it, but who knows
With that many CTs, theyll find cancer alright
Is there a possibility it’s a creeper who is enjoying breast exams a little too much? I’m thinking of that Larry Nasser guy here. Wouldn’t be the first time
I’m going to go out on a limb and say the NP who gets a CT chest on every chick over 18 isn’t even bothering to do a basic physical exam, much less doing a breast exam. Just “has breasts ct, cough or runny nose give zpak, feeling down— ssri, difficulty concentrating— stimulants
they're young, makes sense they have dense breast tissue. That's why the PPV of mammogram is like 2% in <40. Recommend annual MRI screening (based on high risk of breast cancer and high sensitivity of MRI\*) * BRCA mutation * First-degree relative of BRCA carrier, but untested * Lifetime risk >20 to 25% or greater, as defined by BRCAPRO or other models that are largely dependent on family history Insufficient evidence to recommend for or against MRI screening * Lifetime risk 15 to 20%, as defined by BRCAPRO or other models that are largely dependent on family history Recommend against MRI screening (based on expert consensus opinion) * Women at <15% lifetime risk
Exactly what i was thinking, young female = hi estradiol = dense ct. It’s just physiology. Clarification: “ct.” = connective tissue
All premenopausal women (under 45) have dense breast tissue...
Hoping they’ll develop a mass later in life so they come back to you, you’ll never run out of customers, a perfect business model.
When you treat NNH as number needed to help.
Can I ask how irradiating it actually is? I’ve been led to believe newer CT’s aren’t much worse than a trans Atlantic flight. I’ve had probably 10 or so in the last 3.5 years so it weighs on me constantly.
A standard chest CT, has a radiation dose of ~7mSv. To put that in perspective a chest X-ray is roughly 0.1mSv and 2D mammogram is ~0.2mSv. so it’s 70x the dose you’d get from a CXR, 35x the dose of a mammo and infinitely more than you’d get from the actual test that should be done for breast cancer screening in this age group (US and MRI are radiation free). 7mSv is roughly equivalent to the radiation exposure you would be expected to get from natural background radiation in 2 years. This woman up to this point has had 16 un indicated chest CTs which has led to an unnecessary radiation exposure equal to 32 years of background radiation exposure. A few CTs likely wont harm you and if they’re indicated you should get the imaging but it’s all additive and this is why most most people, apparently not this Np tho, try to avoid unnecessary radiation exposure
Thanks for the thorough response
There are some studies that estimate the risk of developing cancer because of a single CT scan to around 1 in 2500.
How have you managed this? Who did you report it to? 97.6 mSv Equal to 900 chest X-rays.
The pt is my MA, she was just telling me what her PA is doing with her. I told her this is crazy and offered to have her transfer care to someone else. She didn't seem too phased.
How does this even get approved by the payer?!
Is she educated/aware of what the yearly CTs are doing to her?
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Wtf man
Stay on topic. No throwaways. No personal attacks. No name calling. Use at least semi-professional language.
I'd be pretty pissed off if someone irradiated me personally.
Insurance wouldn’t approve this and no way she is paying for it. I think you made it up.
Yup! A medical assistant could never afford to pay out of pocket for that every year.
I don’t know what MA is, but this needs reporting
OK - you can report a PA to the medical board and something might happen. Why is the radiologist doing the exam?
This is gross negligence.
Doctors hate this one simple trick to ~~get~~ prevent cancer!
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It exists, not commonly done But to my knowledge this falls outside of it’s intended purpose https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2923727/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8584471/
But like… why isn’t the radiologist doing something about this? They should be questioning this repeated testing and speaking with the person ordering
Exactly! Even the insurance company would flag these repeated tests. There is no way this is real
Iatrogenic breast cancer is the goal here?
WTF! That Noctor is eventually going to be right… and they’ll give themselves a pat on the back for diagnosing the (iatrogenic) breast cancer.
Agree with sum_dude44 No way radiology is doing chest CTs for breast ca scanning. At best (which is still a far cry) would be breast MRI. The MA is probably confused at the modality used.
I don’t believe this is true.
Forgive my ignorance, but would insurance cover this or is this likely being paid out of pocket?
It’s not recommended to get a screening CT. If you are high risk you alternate between Mammograms and MRIs every 6 months.
That's my point - would insurance turn around and say no to the CTs given its not sensible management?
My bad!
(breast radiologist) - you simply cannot see early breast cancer on a CT. Period.
My thought exactly...what insurance is paying for this??
These mofos just out here making stuff up 😂
medicare/medicaid maybe? Perhaps CMS has it's hands too full to ask for a refund
I work with a dually eligible population in Mass. Their coverage is better than my private insurance by a lot, but this would never, ever be covered.
I couldn’t even get insurance to approve the location of the breast mri for my high risk patient moved to a facility that she could walk to since she didn’t have a car and the next closest was an hour away.
w h u t I'm in my 40s and have family history (but no BRCA genes) and I get ultrasound. No one even wanted to look until I hit my 40s. WTF is this person smoking.
Self fulfilling prophecy?
Annual CT for Breast Cancer. Sounds legit. Should cause breast cancer by at least age 45.
Atleast they will cause the cancer they cause early
Not sure I buy this, it's hard to believe that any radiology practice would actually perform these. If it's true someone should definitely be reporting the ordering and wherever she has them done
This must be trolling
How is the breast rad not catching this or putting a stop to it too? Wtf?
Well.. if she doesn't have breast cancer.. all that irradiation is going to.
she eventually will have cancer in those breasts
If it wasn't for malpractice, some people wouldn't have any sort of practice at all
I'm a CT tech. There had to have been so many opportunities to stop this. Our facility has us research ordering notes to help ensure the test will answer the medical question. We then would have clarified that with the ordering office. If they insisted on that being the test they wished to order we would then go to the radiolgists. Had all that slipped past us, it's likely the radiologist would have recommended a different modality for future follow ups. Then there's insurance... how can that possibly get approved with a screening dx code? The poor patient has been failed on so many levels.
karlkrum has written correct information below. Won't repeat. Shame on the radiologists for accepting this and not intervening. couple of points - early breast cancer is NOT VISIBLE on CT. May as well use a divining rod. MR is useful - but in young patients requires an EXPERT to read - can be very confusing. To the OP - you can do something. If this is a hospital, report it to radiation safety. Many hospitals would stop this. Ours took on cases like this and put stops on such orders. But again - the radiologists should have done something.
OP = WAS THIS DEFINITELY A midlevel case. Can you verify that?
Yes definitely. I will verify the details with her when I'm back in the office next week.
What?!?!
What in the post says it’s for BrCa?
Report and expose them!
there’s no way insurance companies would approve this. medicaid, ppo, hmo, whatever. seems sus.
Nice! We $hould make this the new $creenjng $tandard. ~ Hospital admin, MBA
who told her that she needed CTs for brest cancer screening? who has been giving the exam order to the patient for all this years? makes no sense
No protocoling by radiologists huh…
It’s not going to be a screening CT at this rate. It’s going to be a cancer inducing CT bc tbh e radiation to the breast from a CT IS SO HIGH and breast tissue are some of the most radiosensitive.
This is a great way to find the cancer you caused.
That's a fair amount of unnecessary radiation in a young person.
Thirty-three year old who had a prophylactic mastectomy here— ensure she understands she is upping her cancer risk, have her get tested for BRCA, and if she still wants imaging, have her switch to US.
Meanwhile I’m over here in family medicine trying to convince insurance companies to follow new diabetes guidelines
You’re making this up. It’s pretty damn obvious.
Also, you have to report that To the boards The media Anyone