• douglakemd

“It’s NOT a Tumor!”

n Kindergarten Cop, Arnold Schwarzenegger’s character said that line. As a radiologist, I help discover why patients have problems swallowing. The first thing I review with someone is an honest discussion of whether the patient has cancer.


Even with ominous “alarm features” most don’t have cancer.


What are "alarm features?”

Have you noticed weight loss since you’ve had this problem with eating?

Are you experiencing dysphagia, i.e., food getting stuck while eating?

Do you have anemia?


I learned to ask these questions in medical school, but alarm features don’t predict cancer. A large study called a meta-analysis looked at 83 different studies and 57,363 patients to see if alarm features predict cancer. In this analysis, 458 patients had cancer, so 0.8% of the patients had cancer. It turns out, alarm features don’t predict cancer. In other words, 99% don’t have it — 1% do.

If you have EoE, the % is even lower than 1%.


If you’ve read about alarm features on Dr. Google, and it paralyzed you with fear, step out of your fear cave. Your risk of cancer is less than 1%, even if some of these things are true for you.

You must see your doctor and sort this out. They can’t discover the source of your problem from questions or physical exam. Please see your doctor.


When you see your doctor, do me a favor.


Speak. Your. Fear.


Step into your fear cave and pull out the darkest, ugliest, nastiest emotion you can find. Say it. Out loud. One sentence. Speak your fear.


Tell them how it feels. You have fears, and those fears are also part of this problem.


Here’s a sampling of what I’ve heard. Do any of these sound familiar?

I’m scared this is cancer.

I’m afraid to eat meat.

I haven’t told my husband, and I’m not sure I can.

My kids are too busy for me to bother them with this little problem.

I stopped eating out with friends five years ago because I never understand when this problem will happen, and I have to run off to the bathroom to vomit the food out.

I fear hosting holiday get-togethers. Food gets stuck when everyone is around the table. I’m not a proper host when I leave the table. I can’t tell my family.

I’m worried about how much it costs to see all these doctors.

Do you know how much this test costs? How about that one?

I’m 63, and I’m not on Medicare yet. I have a high deductible health plan. All of this is coming out of my pocket.


Here are some ways to work up to this if speaking your fear scares the bejeezus out of you. First, write it down. For your eyes only. Another starting point might be telling your most trusted and loved person. This may be a significant other, parent, adult child, religious figure, etc. For some, this might mean sharing on social media like Facebook, Twitter, Instagram, etc. For some people, sharing on social media is anonymous and easier than sharing with family. Sharing with family may be easier than social media sharing for others. No matter where you share it, help yourself work toward speaking your fear to another human and eventually your health care provider.

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