January 2007—For a while, it seemed you couldn’t go anywhere without hearing about the benefits of whole body computerized tomography (CT) scans as the new frontier in preventive medicine. Even Oprah Winfrey underwent a scan on national television. Anecdotally, people who chose to have the scans said it saved their lives, discovering cancers and heart disease at an earlier, often more treatable stage.

But today, most experts in the field say that while whole body CT provides some good information, it is not as valuable a screening tool as proponents had once hoped. In addition, there are real risks from radiation exposure from yearly scans. Rather than rely on whole body scans, physicians in the field feel they can gather more accurate information from scans that focus on specific parts of the body including the heart, lungs and colon. In addition, they recommend the use of no radiation risk technologies such as MRI and ultrasound to perform many of these scans.

“For people with risk factors who are proactive about their health, I recommend considering the pros and cons of each scanning technology and making an educated decision in concert with their physician,” says Dr. Miles J. Varn, PinnacleCare’s Chief Medical Officer.

Radiation risks of whole body scanning
One risk of routine whole body scanning is radiation exposure. Compared to diagnostic X-rays like mammograms and chest X-rays to screen for lung cancer, whole body scans expose the patient to a higher level of radiation. In fact, a CT body scan delivers 100 times more radiation than a mammogram according to experts at Brigham and Women’s Hospital in Boston.

If you undergo a whole body CT scan every year, your risk of developing cancer increases. A study by researchers from the Center for Radiological Research at Columbia University found that the lifetime risk of cancer death increases after a single whole body CT and continues to grow with each additional scan. A 45-year-old who has one whole body scan experiences a one in 1,250 (0.08%) increase in cancer death risk. If that same 45-year-old undergoes one whole body CT scan a year for 30 years, the risk jumps to one in 50 or 1.9%. According to the study, radiation-induced lung cancer was the main type of disease linked to CT scans.

“Our research provides definitive evidence that radiation risk is associated with full body scans,” notes Dr. David Brenner, lead author of the study and Professor of Oncology and Public Health at Columbia. He also notes, however, that for people who need a diagnostic CT scan because their physician suspects disease, the benefits of the scan outweigh the risks. The concern held by Dr. Brenner and others is that asymptomatic patients who choose to undergo CT scans may accrue only risk and little or no benefit.

The American College of Radiology (ACR) recently stated that it does not believe there is sufficient evidence to justify recommending total body screening for asymptomatic patients at this time. They cite the fact that there is no proof that the screening is effective in prolonging life. Notes ACR Chair Dr. Ari Van Moore, FACR, “There is no data to show that whole body screening has benefits. It can have adverse effects.”

False positives, needless tests
Any screening or diagnostic test can produce a false positive result. Research from the Massachusetts General Hospital Institute for Technology Assessment and the Harvard Medical School found, however, that whole body scans had a very high rate of false positive findings.

The study, which was based on a mathematical model and designed to create estimates of the effectiveness and cost-effectiveness of whole body CT, found that 90.8% of patients had at least one positive finding, but only 2% had actual disease. In addition, the scans added only six days of life to the patient’s life expectancy.

False positives lead to additional tests, some of which carry their own risks, as well as needless worry by the patient and family. While false positive results can be effectively managed when you have a skilled physician guiding you through the process, many body scanning facilities offer little in the way of follow-up or additional information on the meaning of test results.

Another worry of physicians and researchers is that people for whom there are no suspicious findings on the whole body CT will assume they are healthy and forgo other valuable screening tests.

Screening scans can effectively aid early detection
While whole body CT scans may not be the answer for preventive screening, research has discovered that a number of imaging tools are highly effective for the early diagnosis of a range of serious conditions including heart disease and lung and other cancers.

Stemming the heart attack epidemic
One of the most effective screening tools tackles the top killer in the U.S.—heart disease.

“We have to be more aggressive in finding and treating patients with heart disease,” believes Dr. George P. Rodgers, a well known cardiologist and Chair Elect of the Board of Governors of the American College of Cardiology. “You don’t need heavily blocked arteries, angina, or a failed stress test to have a heart attack. In fact, half of those who suffer a heart attack had no previous symptoms of heart disease.”

Standard heart disease risk assessment tools like the Framingham Risk Score place the bulk of patients in the intermediate risk category, but the addition of a coronary calcium score can more precisely pinpoint risk. In one study at the South Bay Health Watch at the Research and Education Institute at Harbor-UCLA, researchers confirmed that use of CT coronary artery calcium scans can help in risk evaluation and steer appropriate patients to preventive treatment. Another very recent study of nearly 5,000 asymptomatic men and women again found that an elevated calcium score effectively predicted coronary events.

“There is a great need for early detection which results in lower mortality and morbidity as well as better health,” believes Albert Barrette, Director of Corporate Development at Inner Imaging, an imaging center affiliated with the Continuum Heart Institute at Beth Israel Medical Center in New York City. “Ultra-fast electron beam CT (EBCT) to uncover coronary artery calcium has a 99% sensitivity rate with no false positives and it exposes the patient to just 50 millirems of radiation, the equivalent of the naturally occurring radiation you would be exposed to on four plane trips to L.A.”

Aggressive cardiovascular screening has also been recommended by members of the Association for the Eradication of Heart Attack (AEHA), an independent organization made up of leading cardiologists and researchers. The AEHA convened a blue ribbon panel known as the Screening for Heart Attack Prevention and Education (SHAPE) task force to examine tools that could help cut the number of heart attack deaths. Panel recommendations included: noninvasive EBCT screening for coronary artery calcium and carotid intima-medial thickness (CIMT) measurement by ultrasound screening of all asymptomatic men between the ages of 45 and 75 screening of all asymptomatic women between 55 and 75 exclusion only of those at very low risk (no lifestyle risk factors or family history of heart disease)

“I think the SHAPE Task Force recommendations are very reasonable,” notes Dr. George Rodgers. “I embrace the guidelines as do many cardiologists around the country. We have to be able to risk stratify patients and get aggressive with those at high risk.”

Lung cancer screening could prevent 80% of deaths
In 2006, more than 13% of men and 12% of women in the U.S. are estimated to have lung cancer according to the American Cancer Society. Recently, spiral CT scans to screen for lung cancer at its earliest stages have been under consideration by a number of research groups.

The most recent study, conducted by a group led by Dr. Claudia Henschke, MD, PhD, Professor of Radiology at New York Presbyterian Hospital and Weill Cornell Medical Center, concluded that screening individuals at high risk (current and former smokers, those exposed to a significant amount of secondhand smoke or to environmental hazards like radon), could result in the prevention of 80% of lung cancer deaths.

The study involved more than 30,000 asymptomatic people at high risk for lung cancer. Of those who took part in the study, 484 were diagnosed with lung cancer, 412 at stage I. The researchers estimated that 88% of treated patients with stage I disease would survive 10 years, while 92% of those at stage I who were treated within a month of diagnosis would survive 10 years. Compare that to those diagnosed at stage III whose five-year survival rate is just 15%.

One concern about the detection of very small lung abnormalities is that some will never pose a threat to the patient’s health, but the patient will undergo biopsies, additional scans and other invasive procedures which carry their own risk. That makes it extremely important that you work with a physician who can help you assess the risks versus the benefits of all procedures you choose to undergo.

Colonoscopy: virtual versus actual
While colonoscopy remains the gold standard for colon cancer screening, virtual colonoscopy does offer some important advantages. The procedure can be performed using either CT or MRI, which poses no radiation risk.

According to Inner Imaging’s Albert Barrette, perhaps the most important advantage of virtual colonoscopy is that people actually go through with it. “Many patients, especially women, are reluctant to undergo traditional colonoscopy,” he has noted. “They’re concerned about both the discomfort and the embarrassment linked to the procedure. Virtual colonoscopy, while not a substitute for colonoscopy, has a sensitivity of 97%. It also allows a higher visualization of the colon. We can see 99% of it, including the exterior wall.”

The best strategy: complete health care
Screening tests are an important component of a thorough preventive care strategy. However, Dr. Dan Cosgrove, head of Wellmax, a progressive preventive health practice in California, asserts, “You should take a complete health care approach which includes not just screening imaging tests, but a comprehensive set of screens including traditional lab tests, a physical exam, genetic screens and a careful consideration of lifestyle and modifiable risk factors.”

PinnacleCare Members can call upon the resources and guidance of their personal Advocate to map out a preventive health strategy tailored to their individual health situation.

A 34-year-old PinnacleCare Member knows the value of that comprehensive approach. During an Executive Physical, the Member exhibited abnormal cardiac symptoms and required more comprehensive testing including a CT scan of the heart. A follow-up blood test also indicated heart disease and treatment was immediately begun. Due to the Member’s young age and the lack of a family history of heart disease, the Member’s internist would never have performed these tests. By taking a proactive approach, this early intervention likely saved the Member’s life.

“Imaging plays an integral role in a complete health strategy, but by adding the data from the other tests you can create a much more complete and accurate picture of your health and plot an effective plan to improve it,” adds Dr. Cosgrove.

Are you interested in a proactive approach to your optimum health? Learn more about the PinnacleCare Live Well Membership.