Doc: Screening test’s value depends on individual risk
Dear Dr. Roach: In my local community, there is an offer for an X-ray test ($99) to see if a past smoker is developing lung cancer. It’s been since 1996 when we both quit. Our doctor says we don’t qualify for the test because of how long it’s been since we quit smoking. Is he trying to say that since we quit in 1996, we will never get lung cancer? What is your opinion?
B. and G.
Dear B. and G.: The test is called a low-dose CT scan. It can find lung cancers, but the real cost of the test isn’t the $99, it’s the possibility of a false-positive test: something that looks like cancer but turns out, after biopsy, to be a benign tumor. The higher a risk someone has, the more likely that any abnormality the test finds is true cancer and not a false positive result, which is why the test is recommended only for those at high risk. In the study that got the screening test recommended by large groups, like the U.S. Preventive Services Task Force, about 25 percent of all participants had a positive test, 95 percent of which were false-positives.
Your doctor can’t say that you won’t ever get lung cancer. He seems to agree, as do I, with the current recommendations that a person needs to have smoked at least one pack a day for 30 years (or equivalent, such as 1 1/2 packs a day for 20 years) and either still be smoking or have quit within the past 15 years to benefit from screening. Doing the low-dose CT scan on people at lower risk makes the risk of false-positives much, much higher than the risk of finding a true case of lung cancer. A false-positive means you would need a lung biopsy, and these can have major complications.
Dear Dr. Roach: My partner had an aortic aneurism repaired in March 2014. He had to have full “zipper” surgery. Eight months later, he had a hernia repaired, which may have been related to the surgery. Since the last operation, over eight months ago, he has gained a basketball-shaped stomach and will not go back to his doctor. I can see distension of stomach tissue through his tight-fitting T-shirts. My concern is that he has developed other hernias. Please advise regarding risks associated with this problem. I am hoping he will heed your advice.
Dear M.M.R.: A hernia is an abnormal opening in the abdominal wall through which the abdominal contents, especially the intestines, can protrude. If they can be gently pressed back in, the hernia is called “reducible”; if not, “nonreducible.” A reducible hernia is a potential danger; a nonreducible hernia is a danger; and a nonreducible hernia with pain is a surgical emergency.
He should absolutely visit his surgeon, since only a careful exam (and sometimes a sonogram or CT scan) by a skilled practitioner can determine the degree of risk and the proper course of action.
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