Radiation=No bueno for breasts

Worried about getting breast cancer from your shower curtain? Don’t be. Instead, worry about getting it from your doctor’s willy-nilly use of radiation.

This month’s Archives of Internal Medicine includes a special report penned by the smart folks at the Institute of Medicine (IOM) and paid for by the deep, politically dubious pockets of Susan G. Komen for the Cure. In a nutshell, the experts said, stop sweating bullets over the noxious chemicals in everyday stuff (ie: bisphenol A in plastics and phthalates in perfumes). Instead, start sweating doctors writing scripts for radiation-based diagnostic tests like it’s a goddamn ticker-tape parade and cancer is the grand marshall.

The IMO starts by stating the obvious. Radiation causes cancer. Um…yeah. Tell it to Madame Curie. And then comes the forehead-smacking stuff. The IMO estimates that “2,800 future breast cancers would result from 1 year of medical radiation exposure among the entire US female population, with two-thirds of those cases resulting from CT (computed tomographic) radiation exposures.” Ironically, many doctors order CT scans to look for cancer. So, in layman’s terms, our fear of having cancer is giving us cancer.

This damned-if-you-do-damned-if-you-don’t news is magnified by the fact that CT use has skyrocketed nearly 5-fold in the past 20 years. In 2012, an estimated 75 million people (half of them women) will have a CT scan.

What doctors don’t tell you (because some of them don’t know) is that in the terms of radiation exposure 1 CT scan equals 500 X-rays. Yes, you read that right. 1 CT scan = 500 X-rays. The real kicker? Up to 30% of those CT scans are unnecessary.

Per my earlier posts, I suspect that radiation exposure in my early teens contributed to the breast cancer diagnosis I received in my late 30s. Of course, no one knows. But this new report adds to a growing pile of evidence that overuse of radiation has serious consequences. (And don’t get me started on CT scans and kids.)

Recap: respect radiation as a diagnostic tool. A CT scan may very well save your life if you have internal injuries from a car accident or a burst appendix. But, if you’re not in immediate danger, ask your doctor about other options. He/she might have to rely on more old-fashioned diagnostic tools, such as skill, knowledge, and intuition, instead of just irradiating you.

Out of Luck

This time last year I felt pretty darn lucky. I’d tiptoed through my breast cancer treatment without awakening its two snarling monsters: chemotherapy and radiation. Now I find myself facing both head on. This coming Monday I’ll have surgery to install a port. Most likely, the following week, the first of 4 rounds of chemo. The decision to move forward with chemotherapy wasn’t easy. The genetic test was decisively vague. After much deliberation, the pros seemed to outweigh the cons (barely). Then again, as my oncologist freely admits, no one knows if chemo will help or not. Basically, it’s a crapshoot. The stakes couldn’t be higher. Maybe I’ll get lucky.

Hurry Up and Wait

Well, last Friday’s appointments with the surgeon and oncologist were anticlimactic (as usual). Basically, radiation and menopause-inducing hormone therapy are definitely in my near future. (Yanking out my ovaries is also an option. Yeah, thanks.) But the “other big C” (aka chemo) is still a tease. Not all breast cancers are sensitive to chemo. My oncologist says he’d be happy to send me to chemo, but it may not work. (Um…yeah, no.) The other option is to order a genetic profile of the new tumor and use that info to make a more evidence-based decision. (Hm…me thinks this sounds familiar.) My first tumor was not cut out for chemo, so we’ll see if this one’s personality is similar. And, since chemo must comes first in the breast cancer treatment buffet, all else must wait. In the meantime, I’m trying to live life as as if a giant meteor isn’t angling straight for me. Easier said than done I’m afraid.

Radiation Mishaps Make News

As I’ve discussed here, I suspect radiation played a role in the onset of my breast cancer. How big of a role? I’ll never know. But between the ages of 12 and 14, I regularly received blasts of radiation for the monitoring of scoliosis. I don’t know exactly how many x-rays came my way in total, but I do know that protecting my breasts was never mentioned.

Later, as a health writer, I grew increasingly wary of medicine’s willy-nilly use of radiation. My concern escalated in 2008 when I wrote a piece for Time Magazine about the potential hazards of CT scans, especially for children. The basis of the story was two studies indicating an increased cancer risk associated with multiple CT scans. I was blown away to learn that each CT scan packs as much radiation as up to 500 conventional x-rays. Of course, CT scans can be a life-saving diagnostic tool and should absolutely be used when necessary, but my reporting found that they are widely overused.

Not to mention, the operator-error factor. One of the most disturbing tidbits I uncovered in reporting that story was from a CT technician who admitted that even though newer scanners can be adjusted to give children up to 50% less radiation (a standard recommendation), many technicians simply forget to reset the machine.

Needless-to-say, I was thrilled to see the New York Times tackle the issue of radiation safety these past couple of weeks, and I want to help them spread the word. What first grabbed my attention was this article about the lack of radiation safeguards. The people most often in harm’s way? Cancer patients.

Thousands of radiation errors are made every year, many of which are never reported to the FDA. Here are just a few of the most egregious examples from the NYT’s coverage, When Medical Radiation Goes Awry:

  • Patient A had just completed treatment for a brain tumor and received additional radiation intended for Patient B, who had breast cancer.
  • A 31-year-old woman with vaginal cancer was overdosed because of confusion over the method of measuring the strength of radioactive seeds…causing an overdose of radiation to her rectum and vagina.
  • A doctor implanted radioactive seeds in the wrong location in a patient with prostate cancer. The radiation oncologist then failed to promptly interpret a post-implant CT scan, which would have revealed the error.
  • A patient with breast cancer received a 50% overdose for 10 treatments because a wedge (a gadget used to shape the radiation beam) was mistakenly left out.
  • Another breast cancer patient, 32 years old, received 27 days of radiation overdoses (three times the prescribed amount).

Thankfully, I’m not the only person who was flabbergasted by the magnitude of these medical errors. The NYT’s coverage culminated today in the news that the FDA is finally going to “take steps to more stringently regulate three of the most potent forms of medical radiation, including increasingly popular CT scans.” I’m not a big fan of the FDA. I think the agency is spread too thin and given too little resources to get the job done. But, at the very least, maybe, someone is finally paying attention.

Radiation Roulette

Another day, another morning spent in a waiting room flipping through an old issue of People. I assure myself this visit will be a breeze—no clueless surgeon telling me I may already be Stage 4, no needles jabbing into a “suspiciously swollen” lymph node, no jaunty pink ribbons of sisterhood. I’m here for a simple pre-surgical chest x-ray. But nothing is as simple as it seems these days. And, as I hear the technician’s monotone instructions–take a deep breath, hold it, let it go–I can’t help but wonder if this is where it all began.

I was 13 years old when our family doctor ran his finger down my spine and announced to my mother that I had scoliosis. I knew the word all too well. Like my peers, I gobbled up every book by Judy Blume, including Deenie the ode to the adolescent angst of scoliosis. The tears began to roll the minute I hit the parking lot.

How many x rays are too many? No one knows, but the orthopedists who mapped my wayward spine seemed to think nothing of ordering them in abundance. Strangely enough, even then, I feared the radiation might damage my ovaries and breasts. How on earth, at age 13, I suspected that radiation was bad news for my budding reproductive system, I’ll never know. (Blume? Was it you?) On the day my anxiety boiled over I mustered the courage to ask the x-ray technician for something to hold in front of my ovaries. I can still picture the quizzical tilt of her head, the you’ve-got-to-be-kidding-me expression on her face. Without looking at me, she handed over a small plate of some kind. I took my best 13-year-old guess and held it beneath my navel. Deep breath. Hold it. Let it go.

Of course, one can’t re-examine every choice. (Maybe I should have held the plate in front of my breasts?) But that doesn’t keep my brain from wandering off to pan the stream of my past for carcinogens. What’s maddening about breast cancer is that I’ll never know what tipped me over the edge. The place I go looking for answers isn’t rational, but I like to visit it anyway. I peruse the statistics, run my fingertips over the risk factors. I find bizarre comfort in the unavoidable ones, such as early menses, but my gut lurches when I seize upon something questionable, something avoidable, like one too many x rays.

As someone who writes about women’s health for a living, I knew my history of radiation exposure put me at a higher risk of breast cancer but I didn’t know by how much. Was I naïve to think I could mitigate that risk by eating a vegetarian diet, staying fit, buying organic? I told myself a few x-rays wouldn’t raise my risk substantially. After all, it was just a little scoliosis; it wasn’t like I was in Hiroshima when the bomb dropped.

Then, on a flight to DC two weeks ago, I opened Dr. Susan Love’s Breast Book. While browsing the chapter on breast cancer risk factors, my eyes snagged on two sentences: “…there are other studies confirming the existence of radiation-induced breast cancer. One showed an increase in the disease among women with scoliosis who had a lot of x rays to monitor their backs during puberty…these studies show that the danger is from exposure to moderate doses of radiation.” Shit.

I’ve spent the past twenty-five years trying to make peace with what happened to my back. Trying to understand how an otherwise healthy young girl with a mild curve ended up in an operating room where surgeons carved a 13-inch incision, deflated a lung, took out a rib, removed a couple vertebrae, and rebuilt her lumbar spine out of metal rods and screws. One week in the ICU. Two weeks in the hospital. Three months flat in bed in a full body brace. Six months in a half-brace. Twenty-five years of thinking—was it worth it? Maybe I finally have my answer.

And that’s how I found myself at 9:15 this morning face to face with yet another x-ray machine. Breasts innocently awaiting another blast of radiation.

This time I didn’t bother to ask about protection; obviously, it’s beside the point.

By this time next week, they will be gone.

Deep breath. Hold it. Let it go.