No scan, no thank you

My dad was an airline pilot for TWA for thirty years back in the heyday of air travel; back when air travel was classy and airport "security" virtually unheard of. I remember how excited I was when we would go anywhere by plane, especially if we went on a flight and my dad was the pilot. We had to "dress" for the occasion. I was required to wear a dress and my brother had to don a coat and tie. Jeans were rarely seen on planes. Many things about air travel now are vastly different, what we wear, airplane food (or lack thereof), our attitude toward air travel, and of course airport security.

I grew up in rural Missouri just outside of Kansas City, which built what was billed as the most convenient airport ever because every gate was mere steps from the curb. We got out of the car and walked across the corridor to our plane. These days, Kansas City's airport, with its walls of glass that now divide that formerly convenient corridor and passenger screening checkpoints set up every couple of gates, seems like an awkward relic of the former age of air travel.

Airport security today is a much more serious matter in light of the harsh reality of 9-11 and the Christmas day underwear bomber. I am willing to endure taking off my shoes, belt and watch; removing my laptop from its case; packing all my liquids and gels in a small plastic bag; and throwing away my bottle of water even though I am thirsty. I wait quietly in long lines and arrive at the airport hours before my flight departs.  I am a compliant traveler, partly because that is my personality and partly because I recognize that the stakes are high and lives are at stake if security is lax.

But I am troubled by the next wave of airport security.

Last week NPR produced a story about new airport security scanners that will soon be deployed around the country. Within the next year, experts expect that two-thirds of airline passengers will be screened with the new technology. While half of the new scanners will use millimeter wave technology, which does not involve any radiation exposure, the other half will use x-ray technology. And while the predicted dose of radiation from any single scan is low, experts are worried about the cumulative effect of this additional dose of radiation on top of other exposures, especially for those of us who have BRCA mutations. These mutations make us less able to repair the damage done by ionizing radiation, thereby making us more sensitive to its effects.

Those of you who have read Positive Results know that any additional radiation exposure when you have a known BRCA mutation is an issue. Even the decision about the age at which to begin annual mammograms is not simple when you have a BRCA mutation. While mammograms can detect cancer and save lives, frequent mammography in young BRCA-positive women may actually cause additional cancers to develop later in life.

I have a number of concerns about screening with these new scanners:

1. The radiation is to all parts of the body.  While mammography does deliver a greater dose of radiation than do the new airport scanners, that radiation is not dispersed over the entire body.  Experts contend that air travelers are exposed to significantly more radiation just by being in a plane flying at 30,000 feet than they will receive from these scanners.  Specifically, they claim that the amount of radiation from the scanner is equal to an additional four minutes of flight time at altitude.  The problem with this argument is that it assumes that maximum radiation exposure is the published "average," which is likely not going to be the case.  Experts admit that the radiation dose to the skin will be higher than the average, but they have not quantified how much higher.  And that is assuming that the machines are calibrated correctly and do not malfunction in a way that leads to overexposure.
2. Because experts concede that skin cells will be exposed to radiation levels higher than the published average and because BRCA carriers are already at increased risk of skin cancer, I am greatly concerned about how frequent use of these scanners will affect our future skin cancer risk.  The fact that we do not know the amount of radiation exposure our skin will get during one of these scans seems particularly problematic to me.
3. Another concern is that many of us fly frequently.  If we spend as much time on planes as do Alex and Ryan in the movie Up in the Air then we are going to be screened with these new scanners a lot.  So far there are no scientific studies that show what effect this additional radiation exposure will have for those of us with BRCA mutations.
4. What about our children?  We already know that childhood radiation exposure is more harmful to those of us with BRCA mutations than is exposure later in life.  Most of us do not know if our children carry our deleterious BRCA mutations because testing children for a genetic predisposition to an adult-onset disease is not considered ethical.  Should we allow our children to be scanned by this new technology?  If so how many times over the course of their long lives will they be screened this way?  What is the total accumulated additional radiation dose they will receive?

Fortunately, we can opt out of screening through this new x-ray technology.  While I am a compliant traveler, for now I will politely decline screening through any technology that exposes me to additional radiation, however small the exposure is estimated to be.  And I will do the same thing for my kids.


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