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Full Body Scams: Not Your Source for Peace of Mind
Annette B. Ramírez de Arellano, DrPH
At one holiday party, a woman announced that she and her husband had decided to give each other “the gift of health” as a present. What could this be? Membership to a gym, a heart-healthy cookbook, the services of a personal trainer? No, what they bought – to the tune of several thousand dollars, even with a “couple’s discount” — was a full-body scan for each. And they had to pay for the whole “gift” out-of-pocket because the procedure is justifiably not covered by insurance.
This technology uses computerized tomography (CT) to screen for early-stage cancers and calcium in the coronary arteries. The ‘full body’ part refers to the fact that the scan delivers radiation from the chin to just below the hips. The machine fires x-ray beams from different directions, providing 3D images of the organs. Because the patient is receiving multiple x-rays, the dose of radiation can be hundreds of times greater than the dose from a conventional x-ray.
These scans have gained popularity as a result of the technological imperative (the belief that if something can be done, it should be done) and a full panoply of marketing tools: an endorsement by Oprah Winfrey, numerous companies touting their services in widely disseminated brochures, direct-to-consumer ads in health magazines, special offers. The ads make use of a vocabulary designed to entice the “worried well,” a not-insignificant fraction of the population, into believing they need this kind of screening. The media hype therefore touts prevention and early detection, and promises “peace of mind” and the possibility of a “clean bill of health.”
Although the procedure is fast and easy, and the result has been described as “dazzlingly sharp 3D pictures of the organs and the plumbing connecting them,” full-body scans are not to be taken lightly. Indeed, the Food and Drug Administration (FDA), the U.S. Task Force on Preventive Services, the American Medical Association, the American Association of Physicists in Medicine, the Radiological Society of North America, the American College of Radiology, the American College of Cardiology, the American Cancer Society and the American Heart Association are all on record NOT recommending these scans for screening of asymptomatic individuals. Their reasons include the following:
1. Full-body scans can produce false positives. They most often uncover harmless abnormalities that may require, at the very least, watchful waiting, but may also result in painful and expensive biopsies, or further scanning. Even when the patient is ultimately found not to have anything wrong, this process can produce anxiety and generate unnecessary services and health expenditures. Some of this additional care may be harmful, thereby subjecting the patient to further risks.
2. Full body CT scans can produce false negatives. However dazzling the images, the pictures in full-body scans are usually not as high in quality or resolution as the images ordered for a specific reason. As a result, some abnormalities may not be picked up, lulling the patient into a false sense of security.
3. Any potential gain must be offset by the risks of radiation. Because the effective dose from a CT procedure is so much higher than the effective dose from a conventional x-ray, the former is justified only when the benefits are commensurate with the outcomes. The American College of Radiology has said that there is no evidence that total body CT scans are either cost-effective or effective in prolonging life. Indeed, there is a danger that repeated scans may result in radiation-induced cancer. The risk for 45-year old persons undergoing a full-body is that one in 1,200 will die from such a cancer. This may seem small, but it is an unnecessary risk to take in the absence of a clear pay-off.
Given the reasons listed above, the FDA Center for Devices and Radiological Health has stated that they “know of no data demonstrating that whole-body CT screening is effective in detecting any particular disease early enough for the disease to be managed, treated, cured and advantageously spare a person at least some of the detriment associated with serious illness or premature death.”
More broadly, Dr. Nortin M. Hadler, professor of medicine at the University of North Carolina at Chapel Hill, counsels against any such indiscriminate screening: “No one should be screened for any disease, ever, unless:
1. The test is accurate.
2. The result has meaningful predictive value.
3. There is something meaningful to be done if the test is positive.”
The partying couple should do well to heed this advice and get themselves a gift that is a true treat rather than a test that is dubious and possibly harmful.