ASK THE DOCTOR: Body scan often unnecessary, invasive procedure
By DR. JIM MITTERANDO
The Patriot LedgerQ I have been thinking of having a body scan that I hear advertised on the radio. What do you think?
A Medical technology is now being marketed directly to the consumer. For a price you can have a full body CT-scan, an ultrasound of your blood vessels or blood tests screening for cancer markers. These services have arisen purely out of a profit-driven motive to make money off people’s insecurities and fears regarding illness and death.
These advertised medical tests are common procedures that are used in regular medical practice when clinically appropriate because of symptoms or risk factors. They are not the routine screening tests such as Pap smears or mammograms or sigmoidoscopy/colonoscopy that may reduce cancer deaths.
These advertised tests have not been shown to reduce disease or death and may, in fact, cause anxiety, additional testing and potentially harmful or deadly procedures or surgeries.
The most recent and heavily marketed test is the full body CT-scan that takes multiple X-rays of the body showing detailed pictures of the internal organs. Unfortunately, the highly detailed pictures may reveal something you have had your whole life that never caused a problem- often referred to as an ‘‘incidental-oma.’’ Distinguishing benign growths from malignant tumors can be difficult during a CT-scan. This will lead to a battery of additional testing that may be invasive and potentially harmful.
Once something is found, you begin a cascade of tests that may spin out of your control. The current medico-legal environment of fear of litigation from missing a cancer may prompt further procedures to evaluate a mild abnormality.
In fact, a body scan does not detect three of the four most common cancers; it will not detect early breast cancer, prostate cancer or colon cancer. Body scans can detect lung cancer but, unfortunately, do not reduce the death rate for lung cancer victims.
One in four people will have a positive scan for a lung nodule most of which are benign and are not lung cancer. These people will undergo potentially dangerous biopsy procedures that can puncture the lung or remove the lung for a benign lesion and subject the person to the risk of death.
General screening of the population for certain diseases such as ovarian cancer and lung cancer should not be done. Detecting these deadly cancers earlier does not save lives. The chances are far greater that these tests will be falsely positive, resulting in anxiety and further unnecessary tests.
Advertisements and web sites offer to check the CA-125 blood test for ovarian cancer screening. In people with no increased risk, this test will be falsely positive 98 percent of the time.
Detecting asymptomatic gallstones or kidney stones are not beneficial and should not be treated unless they become symptomatic. Of the people found to have a positive test for calcification of the arteries in the heart, 95 percent actually do not have any heart disease - yet another high false positive rate.
Ultrasounds of the neck can detect atherosclerosis (hardening of the arteries). But people with no stroke symptoms should not have surgery to clean out the blood vessels since the risk of stroke is greater from the surgery in this instance.
Some screening tests such as bone density have been pushed by the pharmaceutical industry to sell the drugs to treat osteoporosis. Treating osteoporosis for three years with the drug, Fosamax, reduces the risk of hip fractures from 1 percent to .5 percent; this means that 200 people with osteoporosis need to be treated for three years to prevent one hip fracture. Not as promising as advertised.
Our fascination with technology can sometimes eclipse the real health message, which should focus on healthy habits of eating well, exercising, maintaining a healthy weight, drinking in moderation and not smoking. If you live by these good habits, you will feel better, be happier and dramatically reduce your risk of disease
The motto - Do No Harm - is a primary goal of medicine that is sometimes forgotten. We have many great technologies and tests at our disposal that can be beneficial when used appropriately and judiciously. These technologies can also result in potentially harmful and fatal consequences when not used appropriately.
Dr. Jim Mitterando is a family doctor at Health Care South/Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.
Readers should send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at features@ledger.com.
Questions of general interest will be answered in this column. The information in this column is not intended to diagnose individual conditions, and individual replies are not possible. Readers should see their own doctors about specific problems.
Copyright 2002 The Patriot Ledger
Transmitted Tuesday, July 16, 2002