PET-CT
scan
showing
probable
tumour needing further confirmation
What about incidental findings of 'disease' detected during imaging scans of other medical
conditions
a.k.a 'incidentaloma' ?
In
such
cases,
it
is
best
to
discuss
with
the
specialist
to
assess
the
significance
of
that
finding
whether
that
is
clinically significant or whether it can lead to actual disease.
More real case studies:
One of the international consensus guideline on thyroid screeening,
POINT 1:
Early
cancer
may
not
have
have
symptoms.
in
head
and
neck
cancers,
by
the
time
the
patient
presents
with
visible
and
palpable
lymph
nodes,
that
usually
means
the
cancer
has
spread
beyond
its
primary
source
to
the
neighbouring
lymph
nodes
before
travelling
further
to
involve
distant
organs
like
the
brain,
bone
and
live.
So
early
checkups
may
ACTUALLY
detect
the
cancer
in
its
early
stage
before
it
even
produces
symptoms.
Early
diagnosis
=
early
treatment = Good results = good cure rate
POINT 2:
Addresses
the
patient/family's
concern.
As
mentioned,
due
to
the
advent
of
information
and
literally
the
'knowledge
is
at
our
fingertips'
(whoever
poet
that
came
up
with
that
proverb
wouldnt
have
foreseen
how
we
are
so
attached
to
our
smartphone
and
screens
today),
everyone
can
read
and
write
anything
on
the
Internet
and
social
media,
good,
bad
or
ugly
!
Either
way
the
results
of
the
screening
turns
out
to
be,
it
hopefully
lay
to
rest
the
patient/family's
anxiety, concern and the search for answers.
POINT 1:
More
tests
means
more
cost
and
time
spent.
Not
to
mention
there
can
be
more
unrelated
and
non-disease
causing
incidental
findings
noted
on
any
test.
The
medical
community
call
that
‘incidentaloma’.
After
all,
all
medical
test
has
to
be
interpreted
in
relevance
to
the
individual's
patient
condition.
Not
all
'apparently
abnormal'
findings
can cause disease.
POINT 2:
Also
despite
all
the
negative
findings,
there
is
no
guarantee
that
the
patient
can
be
completely
reassured
!
Especially
the
super-anxious
or hypochondriac type !
POINT 3:
Before
purchase
of
any
medical
insurance,
by
the
rules
and
regulations,
the
patient
is
‘obliged’
is
disclosed
any
examination/preexisting
disease
to
the
best
of
his/her
knowledge.
So
any
positive
findings
on
screening
test,
whether
clinically
significant
(can
cause
real
disease),
‘incidentaloma’
or
not,
has
to
be
disclosed
for
your
insurance
underwriters
to
assess.
So
this
will
place you at ‘precarious’ position !
(See real case study below)
POINT 4:
The
example
case
of
thyroid
cancer
overscreening
resulting
in
overdiagnosis
or
papillary
thyroid
cancer
in
a
particular
Asian
country (controversial as this may be)
PATIENT A
Healthy lady in 30’s - has no real medical reasons for thyroid
ultrasound screening scan.
So happened bought medical screening package which included
a thyroid ultrasound screening scan.
Scan done -showed single asymptomatic thyroid nodule about
3mm, non-cancerous looking. Also no risk factor for thyroid cancer.
No sampling done. (then scan pic not available, only report was
disclosed)
Later in a few months’ down, decided to buy medical insurance.
‘Obliged’ to disclose all prior medical tests - including the above
ultrasound thyroid report
As expected, insurance underwriter exluded insurance coverage
for thyroid-related disorder.
Patient A unhappy. Decided not to buy the insurance policy.
Then came for second opinion few months later to my clinic.
Seen for the first time in my clinic.
Repeat ultrasound scan showed perfectly normal thyroid, previous
small nodule had disappeared.
Decided to appeal against the insurance exclusion on thyroid
disorders. Since i felt a worthwhile case to fight for.
GOOD NEWS: exclusion retracted. Patient proceeded to purchase
the poilcy and all went smoothly.
Patient A now happy, so was the doctor
PATIENT B
A foreign national.
For undisclosed reason, did an ultrasound scan at another centre.
Scan done -showed single asymptomatic thyroid nodule 5mm,
non-cancerous looking. Also no risk factor for thyroid cancer.
By international consensus guideline, she surely did nto fit the
critieria for the population to be screened.
Ultrasound-guided sampling then showed Papillary Cancer of the
thyroid gland, the commonest cancer type.
Patient B anxious now.
Then came for second opinion few months later to my clinic.
Seen for the first time in my clinic.
Repeat ultrasound scan showed the same thyroid nodule.
BAD NEWS: Ultrasound-guided sampling i did for
her also confirmed Papillary Cancer of the thyroid gland.
(scan as below)
Patient B decided to return to home country for treatment.
thyroid
head & neck
ear, nose & throat (ENT)
C mmitment
BI PSY
to
What is MEDICAL SCREENING ?
Another
concept
of
well-being
being
practised
widely
nowadays
is
SCREENING.
It
means
subjecting
a
normal
person
without
signs
or
symptoms
to look for a particular disease.
From
a
medical
perspective,
there
are
recommended
criteria
to
screen
any
commmmunity/population
for
any
particular
disease.
There
are
sound
epidemiological and health economics principles behind each recommendation by any medical bodies.
However
in
the
real
world,
many
would
voluntarily
have
themselves
screened
either
by
a
blood
test
or
imaging
(eg
ultrasound,
CT
scan,
angiogram etc). Besides a patient's right to decide, there are many other personal and industrial factors at play.
In our community, these 2 organs are commonly included in the screening patients voluntarily do at other 3rd party centres.
- THYROID ULTRASOUND STUDIES
- NASOPHARYNGEAL CANCER EBV STUDIES
So to screen or not to screen ?
While
we
do
not
have
a
routine
head
and
neck
cancer
screening
package
in
place
as
part
of
our
clinical
practice
for
individuals
without
symptoms
(in
complying
with
universally
advocated
sound,
ethical
and
rational
medical
practice),
we
are
open
to
anyone
who
wants
such
screening
upon
request.
Especially
if
they
have
a
lot
of
anxiety
and
fear,
now
that
everyone
can
read
and
write
anything
on
the
Internet
and
social
media.
After
all,
assessment, biopsies and treatment are something we do on a daily basis and the tools are readily available in the clinic/hospital.
However, the patient has to be aware of the pre-screening counselling and implication as follow.
Pros Vs Cons:
Back to Part 2
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