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Saturday, February 04, 2012
Special Report: February 2006
Too Much Information?
Full-body scans can reveal hidden ills — or plant seeds of unnecessary doubt
Story by Judith Horstman
Oprah had one. So did Whoopi Goldberg and William Shatner.
Full-body screening — a tour of your insides via a computerized tomography, or CT, scan — has been touted for several years as a way to detect hidden medical problems.
The screenings were wildly popular a few years ago among the “worried well”: people with no known health problems or symptoms and enough money to pay for a scan to get peace of mind.
The procedure is advertised and sold directly to consumers. You don’t need a prescription from your doctor to have one, just $700 to $1,000 to pay for the scan, since scans are not covered by most insurance.
Ads for full-body screenings cite people who had no symptoms but were discovered to have serious conditions such as cancer or a potential aneurysm.
These dramatic findings are not common, but the screenings have merit, says Dennis Breen, M.D., a cardiologist and partner in Sacramento Heart and Vascular Medical Associates, which offers full-body scans along with other imaging tests.
“It’s the rare person who has an occult [not accompanied by symptoms] cancer,” says Breen. “Maybe one-tenth of 1 percent, or one out of 1,000, revealed something as drastic as a cancer. That’s very inefficient medicine. But for that one person, it could be life or death,” he says, giving one of his patients as an example.
Annette Capurro, 69, of West Sacramento, had worried for years that she had heart disease. “My mother and father both died young from heart problems,” she says.
A few years ago, an evaluation by Breen didn’t show any heart issues. “He checked me out, we did all the tests, and he said my heart was fine,” she says. But that didn’t satisfy her, so Breen suggested she have a body scan.
Once again, her heart was fine — but the scan revealed cancer in her left upper lung, something she had never suspected, since she had quit smoking 17 years earlier.
She had surgery for the cancer and feels everybody should have a body scan. “It sure would be worth it, even if insurance doesn’t pay for it,” she says.
Breen agrees. But many doctors and major health organizations — including the Food and Drug Administration, the American College of Radiologists, the American Medical Association and the American Heart Association — don’t agree. They say no studies show that CT screenings of asymptomatic people save lives, and that scans can cause more problems than they uncover.
Many major organizations say full-body scans can cause more problems than they uncover. Cardiologist Dennis Breen admits scans are “very inefficient medicine. But for that one person, it could be life or death.”
A scan cannot show every health problem, and it may show small abnormalities that aren’t health issues. If a screening scan shows an abnormality, even something subtle, in today’s medical-legal environment, physicians feel obligated to follow up on those findings, says John Boone, Ph.D., a professor of biomedical engineering at the UC Davis School of Medicine and an expert on medical imaging. This could lead to invasive tests, such as biopsies, that aren’t needed.
Moreover, exposure to radiation increases the risk of developing cancer. CT scans are the single largest contributor of the U.S. population’s radiation exposure from manmade sources, says Boone. The radiation from one CT body scan is about equal to the radiation from 100 chest X-rays.
For people with symptoms, it’s a different story. “There is a very large difference between having a CT scan for the heck of it and one that is recommended by a physician because he or she is trying to determine what is causing a patient’s symptom,” says Boone.
A CT scan can help doctors with a diagnosis. But some people take the process into their own hands.
Sacramento decorative painter David Cocker had been slightly anemic for a decade. He also had blood in his urine occasionally. His HMO didn’t think much of it, other than that he should have a colonoscopy every few years, says his wife, Sharon.
But these health issues nagged at Sharon. At 63, David was in excellent health otherwise. When she saw an Oprah show where a body scan had turned up a large tumor in a young woman, “I said, ‘We’ve got to have this.’ But he just rolled his eyes.”
“I didn’t want to do it,” David says. “It is expensive and I didn’t see any need for it. I thought I was healthy, and it was a hardship to pay the $750.”
Nonetheless, they both had body scans at Sacramento Radiology. Later that day, a radiologist called for David. Sharon could tell from David’s face it was not good news. The scan showed a large kidney tumor and heart disease.
David took the results to his HMO, which did more tests and surgery for the tumor. “They said it was the size of a football,” says Sharon. “There’s no question the scan saved his life.”
The selling of CT body scans has been through some changes in the past six years or so.
After Oprah endorsed the procedure on her show, many entrepreneurs leapt into the imaging business. Some even loaded a CT scanner into a trailer or a van and promoted scans in shopping malls and small towns, a practice some organizations criticized as “retail medicine.”
According to The New York Times, by last year the demand for walk-in, self-referred body scans had dwindled, and many scan services marketed directly to consumers had gone out to business. Those that remain in business in the Sacramento area are imaging laboratories and services that work closely with doctors.
At least three local imaging groups offer body scans: the Sacramento Radiology Medical Group, the Radiological Associates of Sacramento
Medical Group, and Sacramento Heart and Vascular. Representatives from these organizations say they have age guidelines for CT radiation exposure. They say they limit screening to women past childbearing age and men older than 35 or 40.
In the future, studies could show screening scans for specific conditions to be effective — and therefore worthy of insurance coverage. CT cardiac calcium screenings are gaining approval, and studies are under way to evaluate CT screening for former smokers to look for lung disease, for colon cancer and even for breast cancer.
For more information on body scans, go to the Food and Drug Administration’s website at fda.gov/cdrh/ct
