Ask Dr. Keith Roach M.D
Cheap screenings must be weighed against benefit
DEAR DR. ROACH: Two years ago, I took advantage of our local $99 low-dose CT scan for smokers at high risk of lung cancer (I certainly fit the criteria). Still smoking, I had the scan, and it was reported to me that they had 'seen something' and wanted to do a follow-up PET scan. I quit smoking completely, cold turkey, the day before the PET scan, and have been cigarette-free ever since. Vividly, I remember telling myself for many years as I smoked that not if but when I met with the lung cancer doctor, I would not be a smoker.
The doctor told me that 'nothing lit up,' therefore I did not have cancer. They did, however, see a number of nodules all on one side of my lung. The largest was 10 mm in diameter, another 8 mm, then many small ones. He did not know what the nodules were — perhaps the result of a fungal infection (we live close to the east coast of Lake Michigan and have a higher incidence of fungal lung infections in our area).
I've since had two followup CT scans, and the nodules have not changed, either in size or in quantity. I am due for another CT scan six months after the last one, which will be my fourth in approximately 15 months.
The doctor recommended continuing with the standard protocol, which called for another CT scan in six months ('just to keep on eye on those nodules').
So, no biopsy, at least for now. The charge that I saw from the hospital for the PET scan with contrast was $9,000. My co-pay for the PET scan was $225.
It is my belief that I am getting excellent care and advice. I am now working daily, in a number of ways, on improving my overall wellness: physical, emotional and spiritual. I am grateful for all that I have. — A.O.
ANSWER: Despite the seeming low price of the initial scan, the follow-up scans have been very expensive, had no demonstrable benefit to you and have given you a fair dose of radiation. A few people in your situation would have had a nodule grow, requiring it to be removed, and possibly been saved from lung cancer. However, the number of people who need many follow-up scans and never need surgery is large compared with the number who get their cancer potentially cured.
The best news of all is that you quit smoking, but some people use a negative scan as an excuse to keep smoking. We don't know whether people are more or less likely to quit smoking after a scan, and that information is critical to understanding whether the scans have a net benefit or harm.
DEAR DR. ROACH: Are energy drinks safe to drink? Do they cause heart trouble? – L.B.P.
ANSWER: Energy drinks have far more sugar than I think is optimal, and enough caffeine that having more than one or two can cause significant side effects in many people. However, except under extremely high use, they are not likely to cause heart trouble unless a person has existing, significant heart disease. *** Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.co rnell.edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall. com.