Breaking News
February 21, 2018 - Father’s stress affects the brain development of offspring, mice study shows
February 21, 2018 - ESRD Death Declines in Vasculitis Patients
February 21, 2018 - Taking ibuprofen for long periods found to alter human testicular physiology
February 21, 2018 - Google AI device could predict a person’s risk of a heart attack
February 20, 2018 - FDA Approves Domestic Source for Tc-99m Isotopes
February 20, 2018 - Sanofi rejects refund demand faces Philippine suit over dengue vaccine (Update)
February 20, 2018 - Researchers discover that activation of specific enzyme may help suppress tumor metastasis
February 20, 2018 - Blood or marrow transplantation survivors have higher risk of cognitive impairment
February 20, 2018 - Booze Beats Pot at Being Unhealthy: Oregon Poll
February 20, 2018 - Morning Break: ’20 Years Late’; Drugs in the Dirt; Catching Flu in the Dorm
February 20, 2018 - Another piece to the puzzle in naked mole rats’ long, cancer-free life
February 20, 2018 - Scientists identify four viruses that can produce insulin-like hormones
February 20, 2018 - New e-Health solution developed to prevent cardiovascular disease, dementia in senior citizens
February 20, 2018 - New genetic risk score could help guide screening decisions for prostate cancer
February 20, 2018 - Study finds higher risk of stroke among blacks with atrial fibrillation than whites
February 20, 2018 - Physical activity could be used as strategy for diabetes prevention
February 20, 2018 - Researchers develop sensing method for early detection of cancer and diabetes
February 20, 2018 - New wearable electronics could be game-changer for stroke rehabilitation
February 20, 2018 - Immune history influences person’s response to flu vaccine
February 20, 2018 - Serenity Now! Learn to Have Patience with Patients
February 20, 2018 - Computer simulation addresses the problem of blood clotting
February 20, 2018 - Women with type 1 diabetes not protected against coronary artery disease
February 20, 2018 - Persistent bloating can be a sign of ovarian cancer, warns charity
February 20, 2018 - Trump administration proposes rule to loosen curbs on short-term health plans
February 20, 2018 - Key protein involved in epigenetic regulation of gene expression guides skin cell renewal
February 20, 2018 - Heart attack symptoms often missed in women
February 20, 2018 - Diagnosis of celiac disease takes 3.5 years for patients who do not report GI symptoms
February 20, 2018 - Study reveals functional dynamics of ion channels
February 20, 2018 - Study explores link between mortality risk and combustible tobacco use
February 20, 2018 - ‘She Trusted Me, and I’d Turned Her Away’
February 20, 2018 - AbbVie and Voyager Therapeutics collaborate to develop new treatments for tauopathies
February 20, 2018 - Fast food makes the immune system more aggressive in the long term
February 20, 2018 - Therapeutic target for glaucoma could have treatment ramifications for Alzheimer’s and Parkinson’s
February 20, 2018 - Overcoming Negative Reviews | Medpage Today
February 20, 2018 - MyD88—villain of allergies and asthma
February 20, 2018 - Food scientists develop rapid screening technique to detect pesticide residue in vegetables
February 20, 2018 - Lab-grown cerebellar cells may help explain how ASD develops at molecular level
February 20, 2018 - Scientists explore connection between bad sleep habits and stiff blood vessels
February 20, 2018 - New Treatment Apalutamide (Erleada) Approved for Prostate Cancer That Resists Hormone Therapy
February 20, 2018 - Do You Really Need My Signature on That?
February 20, 2018 - HIV-1 genetic diversity is higher in vaginal tract than in blood during early infection
February 20, 2018 - Diabetes does not increase work-loss years due to early retirement
February 20, 2018 - Researchers aim to find out how PTSD affects decisions of police
February 20, 2018 - UH Cleveland Medical Center explores novel treatments for uterine fibroids
February 20, 2018 - Flu Vax Efficacy 25% Against Predominant H3N2 Strain So Far
February 20, 2018 - HIV screening most optimal at 25 years of age if no risk factors
February 20, 2018 - Loyola Medicine primary care physician offers advice to minimize risk of flu
February 20, 2018 - Safe sleep recommendations for parents that may help reduce child’s risk of SUID
February 20, 2018 - Why Do So Few Docs Have Buprenorphine Waivers?
February 20, 2018 - Low levels of alcohol good for the brain
February 20, 2018 - Experimental treatment improves invisible symptoms of a man with spinal cord injury
February 20, 2018 - Myriad’s EndoPredict offers better prediction of breast cancer recurrence, analysis shows
February 20, 2018 - Researchers identify fifteen genes that determine our facial features
February 20, 2018 - Morning Break: New Health IT Player; Luxturna No Bargain; Nuclear Freakout
February 20, 2018 - How does it compare? Hospice care at home, at assisted living facility, at nursing home
February 19, 2018 - Scientists develop water-soluble warped nanographene for bioimaging
February 19, 2018 - It’s Not Your Imagination: You’re Hungrier After Losing Weight
February 19, 2018 - Antihypertensive Use At Delivery Rising in Preeclampsia
February 19, 2018 - A centuries-old math equation used to solve a modern-day genetics challenge
February 19, 2018 - Liquid biopsies could be used as new predictive marker for metastatic TNBC
February 19, 2018 - Russian researchers develop new multi-layered biodegradable scaffolds
February 19, 2018 - Are ‘Vaccine Skeptics’ Responsible for Flu Deaths?
February 19, 2018 - Hidden genetic effects behind immune diseases may be missed, study suggests
February 19, 2018 - Emergency nurses experience regular verbal and physical abuse
February 19, 2018 - Study sheds light on biology that guides behavior across different stages of life
February 19, 2018 - Morning Break: Transgender Breast Feeding; Brazilian ‘Pro-Vaxxers’; Post-Stroke Exercise
February 19, 2018 - Meningitis vaccination strategy in Africa found to be effective, economical
February 19, 2018 - Researchers uncover how excess calcium may influence development of Parkinson’s disease
February 19, 2018 - Psoriasis drug also effective at reducing aortic inflammation
February 19, 2018 - Excess emissions can make serious contributions to air pollution, study shows
February 19, 2018 - Researchers reveal potential biological roots behind individuality
February 19, 2018 - Diabetes Drugs Differ on HF; School-Based Obesity Program Flop; Plaque Type in ACS
February 19, 2018 - Surgical infections linked to drug-resistant bugs, study suggests
February 19, 2018 - Poor awareness may hinder a child’s early dental care
February 19, 2018 - Research finds rising trend in incidence of merkel cell carcinoma
February 19, 2018 - Researchers uncover Ras protein’s role in uncontrolled cancer growth
February 19, 2018 - FDA Approves Apalutamide (Erleada) to Help Curb a Tough-to-Treat Prostate Cancer
February 19, 2018 - Educational Tool Boosts Cervical Length Screening
February 19, 2018 - Spider’s web inspires removable implant that may control type 1 diabetes
February 19, 2018 - Scientists develop fluorescent probe to identify cancer stem cells
Trunk Imaging Tied to Higher Nephrectomy Risk

Trunk Imaging Tied to Higher Nephrectomy Risk

image_pdfDownload PDFimage_print

Action Points

  • A correlation between CT scanning and nephrectomy has been found, especially in larger hospital regions with more than 50,000 Medicare patients, in an assessment of >15 million Medicare claims from across the U.S.
  • Note that during the 5-year study period, 43% of Medicare beneficiaries had either a chest or abdominal CT, with the geographical risk ranging from 31% to 52%.

Medicare patients who live in areas of the country with high rates of abdominal and chest CT exams face a higher risk of undergoing nephrectomy, researchers found.

That correlation between CT scanning and nephrectomy is even stronger in larger hospital regions with more than 50,000 Medicare patients, Gilbert Welch, MD, MPH, of Dartmouth University and colleagues reported online in JAMA Internal Medicine.

The team focused on nephrectomy because it’s commonly performed for kidney cancer, which is frequently diagnosed as an incidental finding on an abdominal or chest CT. In addition, there’s a “growing recognition that not all kidney cancers have the same potential for insidious progression and metastasis,” they noted.

For the study, Welch and colleagues assessed Medicare claims from more than 15 million patients to measure five-year risk of imaging and nephrectomy within each of 306 hospital referral regions (HRRs) in the U.S. During that time, 43% of Medicare beneficiaries had either a chest or abdominal CT, with the geographical risk ranging from 31% in Santa Cruz, California, to 52% in Sun City, Arizona.

They found that an increased regional CT risk was associated with a higher risk of nephrectomy (r=0.38, 95% CI 0.28-0.47), with an even greater association among HRRs with more than 50,000 Medicare beneficiaries (r=0.47, 95% CI 0.31-0.61).

After controlling for adult smoking rates within HRRs, imaging an additional 1,000 beneficiaries was associated with four additional nephrectomies, and the case-fatality rates for nephrectomy were 2.1% at 30 days and 4.3% at 90 days.

The ability to make causal inferences based on the results of the study was limited by its observational nature: “While claims data are a reliable data source for use of medical care … they are less reliable indicators of the reason services are being used,” the researchers autioned. “Thus, we cannot make any judgments about the appropriateness of imaging.”

As for the policy implications of their study, Welch and colleagues pointed to the increasing role of active surveillance in managing small renal masses, particularly for elderly patients. For example, a study presented at the most recent Genitourinary Cancers Symposium reported that a growing number of patients with small renal masses are opting for active surveillance over immediate treatment.

“We believe surgeons should routinely offer active surveillance for small renal masses, and that patients, after being informed about the small risk of developing metastatic disease, should give the option serious consideration,” they wrote.

Welch and colleagues also pointed out that the decision to conduct an imaging test as part of active surveillance should take into account both its potential benefits and harms. And while the radiation risk associated with CT is perhaps the most well known potential harm, they wrote that their findings “suggest that the risk of nephrectomy is more than an order of magnitude higher.”

In a commentary accompanying the study, Rebecca Smith-Bindman, MD, of the University of California San Francisco, wrote that the study by Welch and his colleagues “adds renal to breast, lung, prostate, and thyroid cancers as cancers with increased morbidity from incidental findings or overdiagnosis.”

She argued that the results of the study reinforce the need for clinical decision support tools that consider overdiagnosis as harm, as well as the development of consistent standards on how to perform and interpret CT scans.

A larger discussion about how aggressively to follow incidental findings — particularly if treatment is unlikely to affect survival — is also needed, Smith-Bindman wrote. “But that is easier said than done. Once a suspected cancer is found, it is nearly impossible to ignore. The suspected diagnosis opens a Pandora’s box, so the only way to decrease overdiagnosis is to avoid unneeded tests in the first place.”

The study was partially supported by the National Institute on Aging.

A co-author reported being an investor in Dorsata Inc., a software company that implements clinical pathways.

2017-12-28T13:30:00-0500

Tagged with:

About author

Related Articles