The Problem of Incidentalomas

One unintended consequence of progress in diagnostic technology has been the rise of so-called incidentalomas--findings of potentially serious conditions found while evaluating for unrelated problems.

An article in the Atlantic by Danielle Ofri, M.D. summarizes the dilemma for clinicians, a problem of such magnitude that the Presidential Commission for the Study of Bioethical Issues recently released a report on incidental findings, the subtitle carrying the take-home message: Anticipate and Communicate. 

As explained in the press release, finding incidentalomas "can be lifesaving, but also can lead to uncertainty and distress if they are unexpected or identify conditions for which no effective treatment is available."

Offri describes how "The bioethics commission listened to testimonies from doctors, patients, researchers, and DTC companies. They heard cases in which incidental findings led to life-saving results, and cases in which incidental findings led to unnecessary pain, fear, and cost."

Given the frequency of unexpected findings, the commission advised...

• Routinely warning all patients, research subjects, and consumers of the potential of incidental findings.
• Emphasizing on standard consent forms that incidental findings are the norm and should be expected.
• Developing plans to deal with incidental findings.

Commission Chairwoman Amy Gutmann, Ph.D. states, “More information is not always better," a concept familiar to followers of this blog.

"Healthy Survivors develop a sense of when enough is enough. They know when questions or problems don't have a definitive answer, or a 'best' or 'good' answer. And some questions don't have any answers." (Happiness in a Storm, p110)