Wednesday, July 14, 2010

Incidentaloma

There is a new terminology out there -- incidentalomas -- for things that are discovered accidentally during a test for something else. I've actually read two articles recently about them: here is one by Kevin MD, and here is one from the NYTimes.

The problem with incidentalomas is that sometimes you find something important, say a malignant tumor, and save someone's life, but often -- very often -- you find something that you would never had found and which would never have impacted that person's life. But now that you know about it... you have to find out more, and make sure it's nothing. So you test more. You scan. You biopsy. You may even do surgery.

And to what end?

So...guess what? My breast MRI found an incidentaloma. Actually, two. There are some "lesions" on my liver (which -- I had to check an anatomy chart -- is located just below my breast, so I guess that's why the liver was even in the picture). Also, there is an "area of non-mass-like enhancement " in my left breast. They want to do ultrasounds of my liver and my left breast "just to be sure" or, in medical speak, "for further characterization."

Great.

I spoke to several people yesterday, and everyone agreed that MRIs are very sensitive, and often pick up things that aren't anything important. Everyone said "don't worry." So I'm trying not to worry.

But the larger problem, as these two articles point out, is that finding and characterizing incidentalomas can cause well people to become, well, sick people. The NYTime article's author, Dr. Peter Libby, had this to say about it:
"Yet all invasive procedures entail some risk. If only a small fraction of the procedures occasioned by incidental findings lead to a complication, the overall burden of disease unwittingly induced by investigation may be substantial. In many cases, the “incidentaloma” proves benign, or is better left untreated. Thus, the unintended consequences of screening by imaging can make a well person ill."
I am hoping that I am not one of those people.

P.S. 1-17-13 Incidentalomas are still causing trouble, and are still in the news. http://well.blogs.nytimes.com/2013/01/17/the-fallout-of-a-chance-medical-finding/

4 comments:

Kibbitz said...

Wow. First, I commend you on your rational research. Very helpful.

When does the followup occur? How are you handling the uncertainty? What can I do to be helpful?

adena said...

Thanks for your concern, N. I have to schedule the ultrasounds. I'm not too worried, but it is kind of freaky. Nothing to do right now, but thanks...

mri said...

Just an FYI....if you were ever on the pill, it has a history of creating hemangiomas (a benign vascular ball) in the liver and on the skin. Hopefully, that's all it was. I find it amusing that you sound like you are keeping your sense of humor and calling the finding an "incidentaloma." :-)

We want to educate people about what to look for in a good dynamic mri breast center.

For more information about breast MRI, please visit http://www.mri-breast.com.

Whatever happens, I pray your incidentaloma ends up being nothing at all to worry about.

Christy said...

Hey, this just happened to me recently! I got hard hit in the head and got a CT courtesy of the ER to rule out a brain bruise (which was negative, I just had a slight concussion) but they found a cyst in my brain. Never would have known it was there if I hadn't had the accident.