Very sad, very scary.
What is the cost-benefit ratio for a routine MRI scan every six months?
What is the cost-benefit ratio for a routine MRI scan every six months?
The problem is people have benign tumors and cists and other oddities that show up on the MRI, most of which will never cause a problem. And every time you have something done at the hospital, even something generally thought to be totally safe like a biopsy or a minor excision, there's some (hopefully very small) risk the doctor will make a mistake, or you'll react badly to anesthesia, or you'll pick up MRSA, or something else bad will happen unrelated to the reason you're there.
People have cranked the numbers on this, and what they found is you're more likely to die from an unnecessary medical procedure as a result of one of these scans than you are to be saved by early detection of a problem.
Should I Be Tested for Cancer?: Maybe Not and Here's Why:
http://www.amazon.com/Should-Be-Tested-Cancer-Maybe/dp/05202...
(I haven't personally read this yet, but it's an entire book about exactly this question, and it's very highly reviewed.)
Even if you did see it... what would you do? Surgery, chemotherapy, radiotherapy... these things don't stop a metastatic cancer this aggressive.
Without a cancer treatment that can stop the progression of an aggressive metastatic cancer within a week or two we are powerless to stop this type of death.
This is the cure for cancer we need: affordable routine scans.
Though more scans means more results for doctors to analyze. Hopefully algorithms can make that part cheaper too.
Affordable routine scans will result in massive overloading of the health system with unnecessary procedures, and the complications arising from those procedures will kill more people than would have died otherwise from whatever shows up on those scans.
There is no such thing as an intervention without risk, and that starts with the risks associated with general anaesthesia.
Scanning is one thing, interpreting a scan and deciding when and where to intervene is something that does not scale well at our current level of technology. Basically it needs a human to sit down and spend time analysing the scan to make sure that what is there warrants intervention. So even if the scan costs would drop to 0 you'd still have the component of the interpretation to deal with.
The end result of overloading the system like this is that those with symptoms that need care are less likely to receive it or receive it timely, and that those that didn't need the care will suffer from complications.
Knowing when to scan and when not to scan is a crucial ingredient in giving good care.
What if I get scanned every month and no one looks at them until I start showing symptoms?
My aunt got breast cancer recently. She got mammograms every year but the doctors never saw anything. Finally there was a mass discovered, and a when they went back to look at the old images, they could see it growing.
Once you start screening everyone, suddenly you have this huge population of growths that you have to biopsy in order to determine whether or not they're malignant or not. Your false-positive rate means that you start giving extremely harmful treatments (chemotherapy is itself mutagenic & can cause cancer!) to individuals who if they'd never have been scanned would have remained blissfully unaware of the harmless growth within them & would have had productive, happy lives.
Routine scans are not cost free: They put a huge diagnostic burden on the system & they inevitably mean that you deliver invasive, potentially harmful treatments to people that don't need them.
More information should always lead to better decisions and better outcomes. If it's the case that more information leads to worse decisions then it's indicative of a problem in your rule set, not a problem with your information.
Imagine if taking someone's blood pressure was a multi-thousand dollar test that required specialized expertise to interpret, and could easily lead to misdiagnoses of heart problems. Now imagine that we just got the technology to do it cheaply and easily. It wouldn't make anyway sense to be afraid of testing blood pressure- it's just more information that can lead to a more complete picture of a patient's condition. But that's exactly what my sibling comments are arguing for now with MRI scans.
Also see number 7 in a list of ambitious startup ideas: http://paulgraham.com/ambitious.html
Once you find a tumor you need to biopsy it before you can treat it. There is a small, but non-zero, chance of death from a biopsy. The number of tumors that won't kill you right away is so much greater than the number of tumors that will kill you right away, that this small chance of death multiplied by the large number of people with non-threatening tumors is a larger number than the small number of people with highly malignant tumors.
Imagine if every time someone had really high blood pressure, we had a rule to perform bypass surgery. People would then avoid taking blood pressure because it might lead to surgery. That doesn't make sense- knowing someone's blood pressure isn't the problem, the problem is our suboptimal rule.
I hope cheap diagnostics become common place over the next twenty years so at least some countries can start taking advantage of more information to improve patient outcomes.