Image courtesy of HCWH Europe
When someone is planning to get a prostate biopsy—the main diagnostic test for prostate cancer—the environmental impact of their impending procedure is not usually at the forefront of their mind. However, a Yale-led study by Associate Professor of Urology Michael Leapman did just that: the team examined the environmental impacts of common screening methods like prostate magnetic resonance imaging (MRI) and prostate cancer procedures, estimating that a single transrectal prostate biopsy has the same CO2 emissions as a round-trip flight from New York to San Francisco.
On a global scale, healthcare systems are a major source of pollution and constitute over four percent of global CO2 emissions. Although the environmental impacts of medical procedures are not currently considered when making medical decisions, Leapman urges for a change in attitude within the medical industry to prioritize environmental stewardship that aligns with patient interest without compromising patient care. “Carbon impact comes into question when we have excessive medical care,” Leapman said.
Unnecessary over-screening is a common occurrence, and invasive procedures such as prostate biopsies actually have the potential to harm certain patient populations. As early as fifty years old, men are advised to consider undergoing a biopsy screening to catch prostate cancer in its early stages. Overall, these procedures are shown to reduce death rates; however, for patients who are over seventy or have existing comorbidities, this invasive diagnostic procedure would risk unwarranted side effects, major hospitalization, or even death. This form of medical care is often considered low-value and may harm both the planet and the patient.
“The story is more than just the carbon footprint of one procedure. It is also about making better healthcare decisions that equip patients and physicians with more reliable information for who might need what intervention,” Leapman said. Approximately one million prostate biopsies are performed per year in the United States alone, with more than half of the patients evaluated found to not have prostate cancer at all. His research found that performing one hundred thousand fewer biopsies would avoid over eight million kilograms of CO2 emission, the equivalent of burning 1.1 million gallons of gasoline (larger procedures, such as surgeries, may easily account for more than ten times that amount).
However, this issue addresses a broader problem facing healthcare management. Leapman noted that physicians are not proactive in considering the economic burden, much less the environmental burden, of expensive procedures. Introducing carbon footprint as a price to be considered when making important medical decisions should be implemented in a holistic conversation around when exactly to prescribe medical treatment. This ensures that the patient understands the broader benefits and risks of undergoing an expensive procedure, encouraging physicians and patients to be more considerate of both economic and environmental costs.
Leapman emphasizes that global climate change directly influences public health. “Healthcare providers are not doing a good job if what we are doing hurts the community and our world,” Leapman said. However, the movement towards environmentally friendly healthcare is not easy and faces many barriers to progress. Leapman’s study found that energy expenditure is the largest contributor to the overall carbon footprint calculation (approximately forty percent). In general, hospitals require an immense amount of resources and energy. However, they work within a very thin financial margin for extra expenses, making it difficult for individual practitioners and hospitals to prioritize advocating for greener energy sources. “Federal regulation and oversight may need to come in if our overall goal is to improve public health,” Leapman said. “We need to make some hard decisions about the resources we allocate to ensure we are being good stewards of the environment.”
Leapman hopes that generating more data to clearly illustrate the environmental impact of healthcare will help increase awareness and target areas of excessive medical care. By doing so, necessary modifications can be made to decrease superfluous resource use. Therefore, doctors can make better decisions when choosing appropriate patients to undergo certain procedures, in the interest of both the patient and the planet. Consider the environmental cost of care—the Earth will thank you.