Would annual fullbody X-ray be beneficial?

Factual Questions
1

An acquaintance of mine recently had a case of lung-cancer diagnosed while the medics were x-raying for something else…

So my questions are: would a yearly fullbody x-ray (or some other type of scan) be beneficial for the general population (perhaps over a certain age)? Would the costs outweigh the benefits? And finally, would this yearly fullbody scan do away with (for instance) the need for mammograms etc?

(Actually, one more; if someone knowledgable about x-rays were to look in here, would the radiation dose of a yearly fullbody x-ray be potentially harmful to some degree?).

Thanks…

2

I would be more concerned about false positives–though the radiation probably isn’t good for you. You can end up suffering a lot of stress and unnecessary suffering because of it. By way of comparison, I’m a cancer survivor and the oncologist doesn’t recommend full body x-rays.

For a discussion of the false positive issue in context of mammography, check out Gerd Gigerenzer’s book Calculated Risks.

3

As a medical writer, I’ve done stories on this.

According to the Food and Drug Administration, the amount of radiation received during a CT scan is about the same as the amount of natural background radiation a person would receive in eight months to three years, depending on the size of the area scanned. Compared to the dosage of radiation a person receives from a standard X-ray, which is small, a person receives about 100 times as much from a head CT scan and 500 times as much from a CT scan of the abdomen.

My physician sources tell me that:

o The health risk of a full body scan equates to an additional instance of cancer for one out of 1 million people undergoing the procedure–and that for people under 40, the slight risk probably does not outweigh the potential benefit.

o Generally, patients undergoing CT scans are age 40 or older and have a personal history, such as smoking or industrial exposure, or a family history that puts them at higher risk for heart disease or cancer.

o Despite its potential, full-body CT scanning is not yet a mature field, and “false positives”-results that suggest the presence of disease where none actually exists-remain common.

o CT scanning does not replace tests such as mammograms, Pap smears, prostate-specific antigen screening or colonoscopy, but it is useful for identifying coronary artery calcification that can signify hidden disease, as well as osteoporosis, and tumors in the lungs, liver, colon and other organs

So basically, the expense, the health risk and the chance of false positives probably means they aren’t ready for routine use. That may change as the technology improves and physicians gain experience in interpreting these scans.

But as stated earlier, for certain people with medical histories that indicate the benefit outweighs the risk, it may be a good idea. But only a physician who knows your medical history would be in a position to help you evaluate that.

4

Yeah, but MRI’s provide detailed views inside the body and produce NO radiation, so perhaps a better question might be: “Would yearly MRIs be a good idea”?

5

Medically, it probably couldn’t hurt. Financially and societally, it’s a bad idea.

A minute fraction of the scans would certainly turn up hidden illness and save lives, but every health dollar spent on a comparatively expensive procedure would be a dollar not spent on more productive screenings that take into account a person’s history and specific risk factors.

Also, MRIs and CTs image different tissues with varying degrees of usefulness. So you’d still risk missing certain problems.

6

As a medical reimbursement specialist with a background in radiology, I can answer why these things don’t make good financial sense.

Even assuming that the technology is mature (which, as Malice pointed out, it’s not), the machinery has to be upgraded every couple of years or so. A CT scanner can run $500K to $1M easily, and an MRI machine can cost twice that. This is the main reason why CTs and MRIs cost so bloody much in the first place. (A CT scan of the abdomen and pelvis can easily cost over $1000 before any contrast, and tack on another $500 for the radiologist.) A whole-body scan, assuming that it’s a CT would run, if I had to take a guess, about $2500 to $3000, plus radiologists’ fees.

As far as the insurance company is concerned, these would be considered preventive. It’s true that most preventive care and tests are covered, but these look for and possibly diagnose known diseases. A pap smear looks for cervical cancer. A mammogram looks for breast cancer. An occult-blood test looks for colo-rectal cancer. And so on. Putting someone into a CT scanner on the off chance they have something isn’t going to wash as far as the bean counters are concerned.

From the hospital’s viewpoint, it makes no financial sense because they’d either have to have a dedicated scanner (which costs boucoup bucks; see above), find space for it, hire techs to run it, find a radiologist who can read the scans, and hope that they can persuade insurance companies to pay for them (or find people willing to pay for them out-of-pocket), or they’d have to risk tying up their existing scanners, keeping people with legitimate need from being able to use them, which can be a medical and PR disaster. (Imagine a “child dies because rich person is using machine” scenario.)

All that being said, there is such an animal as a full-body scan (see [url=“http://www.fda.gov/fdac/features/2001/601_ct.html”]for more info). It’s being done now. Whether it’s a good idea is up for debate.

Robin

7

People who don’t deal with X-rays and CT scans tend to grossly overestimeate their benefit, often by as much as 5-10 times.

Doing such tests yearly on a routine basis would pick up a lot of false findings you would then start to worry about. But it would also likely miss things you should worry about.

As a resident, I remember one time when I was working in a family doctor’s office. The patient was a wealthy bank executive who every year got an “executive physical” including GI scopes, a full body MRI, and all sorts of screening tests for many years. None of them picked up that he had Huntington’s chorea, a diagnosis that was obvious to the small town family doctor I was working with within three minutes. Naturally, this person was enraged when told his diagnosis… “I’ve had all the tests and every specialist in Toronto look me over…”, and the trouble was none of them did.

Live healthy and see one good doctor whom you trust regularly for routine care. Show me some evidence that your routine screening applied to a general population saves lives, increases longevity or increases quality of life.

8

How do PET scans compare in terms of cost and benefit?