Behind the Body Scan Craze

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"Save a life—your own!"

So proclaims an ad for high-tech "full-body" scans at a clinic in New York City, one of hundreds of imaging centers popping up in shopping malls and office buildings around the country.

The sales pitch is enticing, prompting more and more of the health-conscious to sign themselves up for powerful X-rays that can reveal cancer, heart disease and other potential killers before symptoms appear.

But whether such intensive testing of healthy individuals with no sign of disease is necessary—or even wise—is strongly disputed by medical experts.

Some doctors endorse full-body CT (computed tomography) scans because they can find trouble spots early, when they are most treatable. "We can save lives," says Kenneth H. Cooper, M.D., whose Dallas Cooper Clinic was one of the first to offer the scans. "With the full-body CT scan, we can pick up heart disease and cancer at their earliest stages."

But much of the medical establishment—including the American Cancer Society, Food and Drug Administration (FDA) and American College of Radiology, among others—does not endorse scans, full-body or otherwise, for people without symptoms. They say the tests often find harmless irregularities that lead to unnecessary, expensive, sometimes invasive procedures.

The scans pick up meaningless abnormalities, such as scars from long-healed infections, cysts and tangles of blood vessels in the liver, especially in those over 50, says Robert J. Stanley, M.D., past president of the American Roentgen Ray Society. "In a large percentage of the cases, these things are not worthy of being evaluated further."

A full-body scan—at a cost of $600 to $3,000 that Medicare and health plans rarely cover—actually examines just the torso, from the neck to the pelvis. The patient lies in a cylinder, and radiation is transmitted through the body, capturing cross-sectional images of tissue. Tiny masses measuring only hundredths of an inch—cancers, aneurysms, kidney stones, as well as benign lesions—are visible.

No one doubts that targeted CT scans are invaluable in diagnosing and tracking certain conditions. Since the 1970s doctors have prescribed them to view specific body areas—the chest, for instance, in a search for lung cancer in high-risk candidates.

"For them, there's a benefit," says Claudia Henschke, M.D., director of chest imaging and health care policy at New York-Presbyterian Hospital's Weill Cornell Medical Center, "because the cure rate for early-stage lung cancer is eight to nine times higher than at a late stage."

But the consumers the imaging business tries to attract—most recently with a wave of celebrity testimonials—are the least likely to benefit from such screening.

"Those that drink to excess, smoke or engage in other risky lifestyles are not likely to get the scan—and they're far more at risk for disease," says James Borgstede, M.D., chairman of the American College of Radiology's patient safety task force. "If you're a seat-belt wearing, non-obese, nonsmoking vegetarian, the chances of finding anything dangerous are very low."

But full-body scans sometimes do find something. Veronica Marshall, 57, a nonsmoking housewife with no known medical problems, signed up last year for a full-body scan to check her overall health. The Alexandria, Va., resident was shocked to learn of a walnut-sized lung tumor, later removed in surgery. "The scan saved my life," she says.

Critics of the elective tests say that experiences like Marshall's are the exception and that most of the time, the abnormalities scans turn up are harmless. "This false-positive sets off a cascade of further evaluations, surgeries and biopsies," says radiologist Stanley. "You end up with discomfort, expense—or worse."

Peter Galier, M.D., associate professor of medicine at the University of California, Los Angeles, says seven patients have brought him scan results showing spots on the liver, pancreas or kidneys. All required more tests, he says, and all the "spots" were found to be benign. "[Patients] are out several hundred dollars—at least—for further testing," he says, "above and beyond the mental anguish of wondering … if they have cancer."

Other concerns about the tests:

• Quality. Many doctors say clearer images of the liver, spleen and other organs are produced by ultrasound scans that make images from echoes of the body's sound waves, or by CT scans that use a contrast agent to sharpen details. Most scan clinics don't use contrast agents.
• Radiation level. FDA radiation physicist Thomas B. Shope says it's 100 to 500 times greater than in a chest X-ray. Some imaging centers say it's only two or three times greater. "You don't just get X-rays for the fun of it," says Robert Smith of the American Cancer Society. "Radiation doses are cumulative over a lifetime."
• False sense of security. "To say you have a clean bill of health based on the results of one test is a terrible mistake," scanning advocate Cooper concedes. "This is only part of a comprehensive exam."

Michele Meyer is a freelance writer in Texas.