Distressed Test: Will a full-body scan find what ails you?

Published in the Philadelphia Daily News March 22, 2004

YOU MAY HAVE seen the ads. “How 17 seconds can save your life,” reads one promotion for a center in Cherry Hill, N.J., featuring a middle-aged, vibrant-looking couple.

Health centers are marketing full or whole-body scans to “the worried wealthy,” as some have coined them. “They’re popping up all over the place, mainly as business opportunities,” said Dr. Mitchell Schnall, a radiologist with the University of Pennsylvania. “Entrepreneurs are saying there’s a market there.”

Why wait until your doctor says you may be at risk for a heart attack or cancer? If you’ve got the money, why not find out now just how clogged your arteries are or what previously unknown, potentially dangerous lumps might exist inside your body?

Advanced computer tomographic, or CT, scans are making such noninvasive excursions into the body more attractive, and the procedures are increasingly being pitched directly to the public. People may pay hundreds for individual scans, which are generally not covered by insurers, or into the thousands for packages.

The Princeton Longevity Center, in Skillman, N.J., for example, offers a Titanium Executive Physical – including a full body scan, blood work, a stress test, consultations with a nutritionist and exercise physiologist, a bone density test and other workups – for $2,500.

During your day at the PLC (which also includes breakfast and lunch, a thick report with your results and a consultation with a doctor at day’s end), you can also choose to undergo a virtual colonoscopy for an additional $1,200.

Dr. David Fein, PLC’s founder, said that testing at his center can “make the difference between being 75 with a walker and being 75 on a cruise ship.”

However, other doctors point out that there have been no conclusive studies showing that full-body scans lengthen life or improve the quality of life.

While clients and some doctors, including Schnall, defend people’s right to take these tests, there are risks involved.

Who gets scans and why

Fein said that at his center clients are 80 percent male and often work in the financial world.

He has been practicing general internal medicine for 18 years and said that before he founded his center in the summer of 2002, he felt “frustration with not being able to do what I wanted to do for patients.” He wished he had more time to talk to patients and gather diagnostic data.

Now doctors in his center see at most three patients a day and analyze their health concerns using information for a battery of sophisticated tests, some gathered from a $2 million electron-beam computed tomographic body scanner (EBCT).

The scanner created detailed images of the body’s internal organs.

Anthony Wild, CEO of MedPointe, a specialty pharmacy company, wanted to encourage his senior management team to stay healthy, so he arranged for physicals at the PLC as an executive perk.

“In terms of potential return on investment, each one of our senior management team is very expensive to hire,” Wild said. “To invest $2,000 for a checkup and to provide people with counseling on fitness seemed to be a good investment.”

Larry Durso, who works for Wachovia Securities, decided on his own to go to the PLC. He had been to a similar center in New York but was unsatisfied because one of his tests was misread, meaning he had to pay for unnecessary additional testing. At 50, he has diabetes and wants to lose 100 pounds, so he wanted to be sure he had no unknown health risks before starting a rigorous program of diet and exercise.

Scans told him that he’s “fit and fat.” He liked the PLC program because it was “one day out of my life and at the end of the day, the doctor gave me a big report, and the center did nice follow-up work.

Durso worked out a diet and exercise routine with PLC specialists.

Though a portion of his testing was covered by insurance, he didn’t care if he had to pay out of pocket. “This was for my peace of mind.”

What are the risks?

Dr. James Borgstede, vice chairman of the board of chancellors of the American College of Radiology and associate clinical professor of radiology at the University of Colorado Health Science Center in Denver, is flatly against full-body scans.

• “First off, there’s false positive examinations,” he said. Suspicious findings that turn out to be nothing, or benign, can cause anxiety, generate cost to the individual and the health-care system in general and may even be life-threatening. If a growth were found in the lungs, for example, surgery to remove it could be very dangerous. One study found that 90 percent of abnormalities found in lung CT scans were benign.
• False negatives. “There’s a potential for people to leave a scan thinking they’re healthy, when in fact they’re not,” Borgstede said. “These scans are at best a snapshot in time.”
• Even if an abnormality is picked up, “you can’t say that because you pick up an abnormality that the patient is going to live a longer and more healthy life. That is the implication in their ads. It’s not true,” Borgstede stated. If a cancer has spread, for example, detecting it might not prolong a person’s life. And “a person could still die in an auto accident or by other causes,” he said.
• Viewed globally, the costs of the tests are not warranted. “These scans will break the bank of the health-care system if they become widely accepted,” Borgstede said, noting that even if the cost of the scans is not covered by insurers, the follow-up procedures might be.

What if it finds something serious?

People like Kevin Helliker (see sidebar) are grateful they discovered a serious health problem before it was too late.

Helliker was not in an at-risk population but discovered an aneurysm during an exam at the PLC. Dr. Fein said he finds worrisome problems – including tumors, aneurysms, blocked arteries – regularly in seemingly healthy people.

“That’s marvelous,” said Borgstede. “I do 30 to 40 CT scans in my practice a day for indications. Occasionally I have an unsuspected finding. Those are what we would call anecdotal stories. We have to look at this from an epidemiological point of view. What are the benefits to the population at large?”

What are the alternatives?

The ACR’s Borgstede recommends that rather than going for an expensive scan, “spend the money on a visit to your family physician,” who would be more likely to detect common problems such as diabetes and high blood pressure.

Besides, the recommendations following a full-body scan would likely be the same advice you’d get after a physical.

Even the PLC’s Fein said that the “biggest factors” influencing health are “body fat and exercise.” A healthy diet and exercise program may reduce cancer risk by up to 70 percent and the risk of heart disease by an even larger percentage. But to be told you need to diet and exercise is boring old news.

As Penn’s Schnall noted, “The greatest value of [whole-body scans] is to scare people to make them actually comply. Everyone should do these things anyway. But if it pushed people to comply with good health standards, that’s valuable potentially.”

What Scans Can and Cannot Find

A whole-body scan my uncover:

• Heart disease
• Lung cancer
• Prostate enlargement
• Vascular disease
• Kidney/gallstones
• Aortic aneurysms
• Disease of the spine
• Pelvic disease
• Liver disease.

But it cannot find such common diseases as:

• Diabetes
• High blood pressure
• Blood-borne illnesses, such as HIV.

‘It Came as a Big Shock’

Wall Street Journal reporter Kevin Helliker went to the Princeton Longevity Center on assignment, planning to write a first-person account of the center’s tests.

A fit, 43-year-old triathlon runner at the time, he felt sure that he would ace all the tests. However, an EBT san revealed that he had an aneurysm measuring 4.6 centimeters in his aortic artery, just above his heart.

“It came as a big shock,” Helliker said.

Commonly, the only symptom of an aneurysm is sudden death. However, an aneurysm can be surgically removed, a procedure that’s recommended when an aneurysm reaches 5.5 centimeters.

Eighteen months later, Helliker’s aneurysm has not grown. Some doctors have told him he might spend his life worrying needlessly about something that might not enlarge. But Helliker is glad for the knowledge.

“My view is that I’m very lucky to know about it,” Helliker said by phone from his Chicago office. “I actually think that if you deal with it, it can potentially improve not only the length of your life but the quality of your life. Because there’s something to be said for having to face your mortality.”

Now 45, Helliker is engaged. “Clearly that’s a sign of belief that this thing isn’t going to kill me,” he said of his engagement.

Though, for example, he has not recommended that his fiancée have a scan, “I defend anyone’s right to do it. I don’t think it’s a sign of being a hypochondriac, or immoral. Without question, it can save lives.

To Scan or Not to Scan?

Besides controversial full-body CT (computed tomographic) scans, some health centers offer more targeted, noninvasive scans on demand.

Some of these targeted tests, when administered to a specific population, are gaining medical acceptance. Generally, these tests are not covered by insurance, although a percentage of insurers may cover some tests.

Full-body scan: A scan from neck to pelvis. Dr. James Borgstede, a spokesperson for the American College of Radiology, said, “We’re opposed to whole-body screening CT examination for the public at large.”

However, Dr. Mitchell Schnall, a University of Pennsylvania radiologist, stated, “People should have the right to sell and get the procedure as long as advertising conveys what is known and not known.”

Cost: $700-$1,300. Not covered by insurance.

Heart scan: A May 2003 study in Circulation: Journal of the American Heart Association recommended electron-beam computed-tomography scans, which reveal calcium deposits in artery walls, to those at medium risk of heart attack. This group was defined as men over 45 and women over 50 with at least one risk factor, including diabetes, hypertension, high cholesterol or a family history of heart disease.

The study found it was not appropriate for those at low risk of those at high risk (for whom the test would be redundant).

Cost: $400-$500. May be covered by insurance.

Virtual colonoscopy: CT colonography takes 20 or 15 minutes, as compared to two hours for a conventional colonoscopy, and requires no sedation or recovery time.

A recent study published in the New England Journal of Medicine found virtual colonoscopy comparable to conventional colonoscopy in finding polyps of 6mm or larger. Virtual colonoscopy even found some lesions missed by conventional colonoscopy.

Cost: $900-$1,200. May be covered by insurance.

Lung scan: A 20-second CT scan my be advisable to those at high risk of lung cancer: people 60 and over who have smoked at least a pack of cigarettes a day for 10 years, or two packs a day for five years. A large ongoing study is looking at whether CT screening saves lives.

Cost: $300-$450. May be covered by insurance.