No symptoms and no complaints, perfect — we are presumed healthy.
Every single one of us is also presumed neurologically healthy. At least until 60 years old when age-related changes are supposed to show up on a medical image of the brain.
Let's talk about things that can affect the healthy functioning of the central nervous system. In other words, the brain. Brain functioning depends on internal and external experience. Healthy functioning of the brain may be interrupted or permanently altered by many bacterial, viral, fungal, and parasitic infections. Hormonal changes, vascular condition, diet, exercise, nature, music, all things are known to affect brain functioning. A simple example is a migraine that affects 10% worldwide.
On the other hand, behavioral problems in healthy adults have nothing to do with your brain structure ( that is considered by a radiologist a normal brain for your age group). Moody, irritated, passive-aggressive, narcissistic, obsessive — you would not expect that it has something to do with faulty brain anatomy, right?
What happens when a healthy person (with no symptoms and zero complaints) has a brain Magnetic Resonance Imaging (fMRI)? What are the chances that something severe and unexpected could be found on imaging of your body or brain? Will the early discovery of a life-threatening tumor save your life? Or will clinically irrelevant false-positive findings confuse you and result in no health advantage at all?
According to research, medical screening is only potentially beneficial. Stanford researchers reported that healthy volunteers recruited to independent brain imaging studies might discover something they did not anticipate. Incidental finding.
Incidental findings are an unexpected anomaly in the medical image study. The finding identified by chance also called incidentaloma.
Would you want to know? Would you worry? Yes, I bet.
Bioethics recognizes the “right not to know” when it comes to medical screening and genetics. However, ninety-seven percent of healthy volunteers who participated in an explorational study declared the wish to know regardless of the findings. The truth is that a substantial number of seemingly healthy adults will have potentially dangerous incidental findings on MRI. What is not entirely clear is the link between early intervention and longer and healthier life. Is it a benefit or harm to act on false-positive or clinically insignificant incidentaloma? In the Netherlands, for example, it is forbidden by law to get a whole-body MRI without having symptoms warranting the test. Other countries like Canada, Japan, Germany allow private preventive health checkups, including whole body and brain MRI. In the era of advanced medical technologies, one in three healthy patients will have unexpected findings when the brain or body is scanned.
One in forty healthy kids and young adults consented to a brain MRI will find out that something isn’t quite right with the image. And one in every twenty-six adults without health complaints undergoing MRI of the body or brain will face the discovery of incidentaloma.
Knowledge of the existence of something wrong inside the body diminishes the quality of life, especially when no treatment exists or needed. People with diabetes, in general, have higher chances of discovering unexpected unrelated to diabetes finding — one in ten people with diabetes report having abnormal imaging. A family history of Alzheimer’s or other neurodegenerative disease puts a person at pretty high risk. One in three first degree healthy relatives of Alzheimer patients without any symptoms of memory loss or cognitive deficit could be flagged as having abnormal brain MRI.
And chances are steadily increasing with age. Every second patient with cognitive symptoms will receive a diagnosis of neurodegenerative disease, the condition that reveals brain anomaly. Unfortunate luck with incidentaloma runs in the family, according to an Australian study. The study subjected healthy older twins to brain imaging. “Silent” findings of brain structure are heritable, especially when it comes to white matter lesions. Australian identical healthy twins had similar unexpected “silent” injuries in the brain.
“Should a clinician or researcher disclose incidental results?” asks Carolyn Ells from McGill University in Montreal, Canada. She proposed that “before the fact,” patients need to determine and disclose the action “in case” incidentaloma is detected. The patient should make his preference known and have a realistic expectation about the usefulness of the test.
Anna Deveaux, M.Sc. is a learner, writer, biotech investor who is interested in research translation, drug development, genetics.