Incidental Finding

I’ve always thought the term “incidental finding” was strange.

“Incidental finding” is something doctors say when they look for one thing but then find something completely unrelated to what they were originally looking for.  For example if you have a chest x-ray looking for an infection, but instead we find a large shadow which may be cancer, we call this an “incidental finding”.

Like many things in the world of medicine we use fancy terms to describe things.  A GP friend of mine told me how he once saw a patient who came in with an itchy bottom.  My GP friend then diagnosed the patient with “pruritus ani”.  The patient turned around and said; “That’s clever, you just took what I said and said it in Latin!”.

Incidental finding is actually code amongst doctors for “Pain in the ass!”.  We absolutely hate it when we find something that we didn’t want to find.  It means more work for us, more investigations, more referrals and more tension for the patient.  A lot of the times these incidental findings turn out to be nothing.  I’ve seen patients who have had brain scans which incidentally find a lesion which shouldn’t be there.  They go on to have months of investigations, some of which are quite invasive, only to be told that there’s nothing to worry about.

This leads doctors to go on and complain about how patients nowadays are being “overdiagnosed” and benign problems are being medicalised*.

I personally find this attitude really shocking.

I get the feeling that in a hundred years time we’ll look back at how medicine is being performed today and be terrified at how primitive our approach to healthcare and preventative medicine is.  I feel people in the future will look back in terror the same way we look back in terror at a time without antibiotics or vaccinations.  “Those poor people!” they’ll say.

It wouldn’t be surprising if in the future we have advanced diagnostic tools which could diagnose all sorts of cancers and other medical problems with a  drop of blood.  Actively looking for incidental findings will probably be approached the same way that we approach screening for certain other medical problems already (such as breast cancer and bowel cancer etc).

I am sure that currently, people in the general population are walking around with ten or so pre-cancerous lesions which could all potentially turn in to cancer at some point.

I say bring it on.  Let’s embrace these “incidental findings”, figure out what to do with these lesions and try and move medicine forward.  We should be actively trying to find these incidentals, seeing how they progress and what we can do about them now.  It’s the way medicine is heading in any case and fighting it just seems like the wrong thing to do.

*When I was a first year doctor, I remember speaking to one of the radiology consultants at the hospital.  He was telling me stories about when the hospital had bought its first CT and MRI scanners.  They were bombarded with these incidental findings, something which they didn’t expect at all.  As a result they had to make up what to do with these findings as they went a long.  There are guidelines in place now for these lesions and what to do.  However, it still surprises me that we haven’t gone one step further and started to find cheap effective ways to actively look for these lesions.  I can’t begin to think of the number of cancers which could be killed at an early stage if this was feasible.  Perhaps an idea for a great startup….for someone much smarter than me!

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