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It’s getting harder and harder for medical doctors to obey their Hippocratic Oath and ‘do no harm’ — especially when they employ radiation.

New research published by the American Medical Association shows that the increasing in the use of CT scans — formally called X-ray computed tomography — in pediatrics raises cancer risks from exposure to the scans’ ionizing radiation, the New York Times reported July 16.

According to the study, the four million CT scans of the head, abdomen/pelvis, chest, or spine conducted on children under 15 in the U.S. every year “are projected to cause 4,870 future cancers in children under 15.”

Lead author Diana L. Migliorette, a professor of biostatistics at the University of California, Davis — writing online in June and August 1st in the American Medical Association’s journal “JAMA Pediatrics” — evaluated the CT scans conducted on children under age 15 between 1996 and 2010 in seven U.S. health care systems.

Averaging the dose of radiation delivered to the head, abdomen, chest or spine, Migliorette and her colleagues found that as many as 25 percent (one million) of the children got 20 millisieverts or more from a single scan. This is 100 to 200 times the dose from an average chest X-ray’s which delivers between 0.1and 0.2 millisieverts. All this ionizing radiation increases the risk that these children will develop cancer later.

Migliorette’s research also reinforced two significant findings made in 2006 by the National Academy of Sciences. The new study found that any given dose of radiation is more harmful to girls than it is to boys, and is especially more dangerous for younger patients than for older ones. In the author’s words, “Projected lifetime attributable risks of solid cancer were higher for younger patients and girls than for older patients and boys.” (www.ncbi.nlm.nih.gov/pubmed/23754213)

The authors warn that “The increased use of CT in pediatrics ... has resulted in many children receiving a high-dose examination. “ They recommend that parents ask tough questions of the doctors: How will a scan change my child’s medical care? Are there other tests that can be substituted?” and “What are you doing to make sure the dose is as low as possible?”

Migliorette notes that dose-reduction strategies can dramatically reduce the number of radiation-induced cancers. But parents have to stand up for precaution and advocate for alternatives.

GAO: Doctors who stand to gain, over-recommending radiation treatment and CT scans

In a related shocker, Congressional investigators report that doctors with a financial interest in radiation treatment centers are “much more likely to prescribe [radiation] treatments for prostate cancer” than those without stock in the facilities.

In their July report (“Higher Use of Costly Prostate Cancer Treatment by Providers Who Self-Refer Warrants Scrutiny”), investigators from the Government Accountability Office say that even though alternate treatments may be just as effective — and less expensive — a similar pattern of doctor-recommended but unnecessary scans is evident, “when doctors owned laboratories and imaging centers that billed Medicare for CT scans...”

A common treatment for prostate cancer is intensity-modulated radiation therapy (IMRT). It directs highly concentrated radiation doses at tumors. “While there are multiple effective treatments for prostate cancer, IMRT is one of the most costly options,” the GAO auditors noted, and patients were often unaware that their doctors stood to profit from the use of radiation therapy.

Senator Max Baucus, D-Montana, told the New York Times August 18, “When you look at the numbers in this report, you start to wonder where health care stops and profiteering begins.” Representative Sander Levin, D-Michigan, said “this analysis confirms that financial incentives, not patients’ needs, are driving some referral patterns.”

The Times also interviewed Dr. Michael L. Steinberg, the chairman of radiation oncology at the UCLA medical school. Steinberg he was “extremely concerned” that older male patients are getting unnecessary treatment. “Some physician groups are steering patients to the most lucrative treatment they offer, Depriving patients of the full range of treatment choices, including potentially no treatment at all,” he said.

The most common cancers caused by radiation exposure are thought to be lung cancer, breast cancer, thyroid cancer, stomach cancer and leukemia, according to a 2007 report in the “Journal of Magnetic Resonance Imaging.”
-- John LaForge is a -director of Nukewatch, a nuclear watchdog and environmental justice group in Wisconsin.