YSM Issue 96.2

Environmental Science
FOCUS
THE CARBON
FOOTPRINT
OF CARE
The unexpected
environmental impacts
of prostate biopsies
BY JESSICA LE
IMAGE COURTESY OF WIKIMEDIA COMMONS
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 CO 2 emissions as a roundtrip
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 CO 2 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 patients. 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
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million kilograms of CO 2 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. Then, doctors can make better decisions when choosing
appropriate patients to undergo certain procedures, in the interest
of both the patient and the planet. ■
May 2023 Yale Scientific Magazine 11