March 8, 2013
IF IT'S BENIGN, THERE'S NO HARM IN WAITING, IF MALIGNANT, NO USE ACTING:
Our Wait-and-See Culture (ROBERT J. ABRAMSON, 3/08/13, NY Times)
Posted by Orrin Judd at March 8, 2013 7:25 PMUnexpected finds -- which the medical community has labeled "incidentalomas" -- are ever more common because of an increase in scans, driven in part by legal concerns. For me, the concept of incidentalomas went from somewhat abstract to all too real when, about two years ago, an abdominal sonogram of my bladder revealed an abnormality on my pancreas. Pancreatic lesions have always had an ominous air about them because of the historically high mortality rate for pancreatic cancer, but luckily an M.R.I. and an endoscopic ultrasound confirmed the lesion as a cyst with very low malignant potential. I was advised to follow up in six months. [...]As the physicist Niels Bohr said, "prediction is very difficult, especially about the future." But this is the exact position that many physicians and patients find themselves in. We must make life-altering decisions based on incomplete information. In my case, the decision to follow up in six months appeared to be the prudent one -- and it turned out to be the right one as well. My six-month follow-up revealed the lesion unchanged. It was recommended that I follow up in another 6 to 12 months.Welcome to the "follow-up culture."