Fast peek inside the body

Medicine: Healthy people are beginning to ask for full-body CT scans, but doctors say they're more likely to waste their money than to find hidden disease.

April 01, 2001|By Benedict Carey | Benedict Carey,LOS ANGELES TIMES

The good life is what brought David Clark to the Beverly Hills, Calif., office of radiologist Stephen Koch. Good food and drink, tobacco and any other pleasant poison the 42-year-old ran through his system before thinking much about health.

"Hey, I smoked a pack a day for six years, back when I was in my teens, and I still like to go out; I like my martinis," says Clark, a business consultant living near Los Angeles. "And I'm thinking, 'Have I screwed myself up? Am I going to have to write my obituary now?' "

It's that kind of morbid curiosity, along with some shrewd marketing, that has put Southern California out front in yet another controversial health trend: full-body CT scans to search for hidden disease.

The appeal of the scans is easy to understand. The machines use computed tomography, or CT, to produce X-ray cross-sections of the body that are much clearer than traditional X-rays and allow doctors to zoom in on abnormal-looking spots. The test is quick and painless, and 20 minutes later you're sitting by a computer screen, watching a virtual tour of your own body.

" 'Star Wars' stuff," says Robert Antin, 50, who visited Koch the same day Clark did.

Despite doctors' warnings that the scans are unjustified in healthy people, programs such as Koch's InsideTrac, and similar ones elsewhere in Southern California, are packing them in. Thousands of men and women have been screened, many of them middle-aged professionals, and some swear the technology saved their lives.

"There's no question about it for me," says Richard Stone, a 58-year-old real estate investor whose InsideTrac scan found a 3 1/2 -centimeter node on his left kidney. Stone had the kidney removed, and doctors confirmed that the lump was cancerous.

"I think the full-body scan is one of those things you can't afford not to do," Stone says.

Don't forget your checkbook, though. Most insurers don't cover the $800 to $1,500 price tag, for the same reason doctors are skeptical of widespread CT screening: There's little evidence that full-body scans of healthy people are cost-effective, compared with standard, and far cheaper, means of detecting disease, such as blood pressure monitoring and mammograms.

For every Richard Stone, doctors say, there will be patients for whom the scans find suspicious- looking spots that turn out to be nothing, putting people on a treadmill of follow-up tests for no good reason. And even a clean CT scan may have unintended consequences, if it encourages people to ignore the usual advice about exercise, diet and regular physicals.

"The marketing is simply way ahead of the science on this -- more so than any other testing in medicine that I know about," says Dr. Howard Hodis, who's doing a study of CT scans and heart disease at the University of Southern California School of Medicine. "I wonder whether people who are having the scans know what they're getting."

A full-body CT involves several scans, Koch says. One runs from the neck through the pelvis and can pick up all sorts of odds and ends, from kidney stones to small tumors to abdominal aneurysms. Herniated, or "slipped," discs often show up, radiologists say; small cancers of the skin, prostate and breast usually do not. The pictures may also detect organ inflammation or deformities, but doctors say they tell you little or nothing about how most organs are functioning -- whether you're beginning to stress your liver, for example, or eroding your stomach lining.

If it's truly comprehensive, radiologists say, a full-body CT should also include separate scans for three things in particular: spots on the lung, spots on the colon, and arterial calcium, which is often associated with heart disease. These three findings account for the vast majority of referrals coming from whole-body clinics, doctors say.

Doctors begin screening for colon cancer when people turn 50, using tests such as sigmoidoscopy (a partial scope of the colon) and a barium enema. But the most sensitive test for the cancer -- colonoscopy -- involves threading a scope all the way along the colon.

"Uh, no, thank you," Antin deadpans. "I'd rather pass."

So far, most of what doctors know about colon scans comes from studies of patients who already have polyps -- a high-risk group, says Dr. Joel Fletcher, a diagnostic radiologist at the Mayo Clinic. "The scans are about 85 percent as sensitive as a colonoscopy in this group, which is very good," he says. "But the sensitivity of any test drops once you start doing it in normal, healthy people. For now, we would recommend that people just get over it and have a barium enema, a sigmoidoscopy or a colonoscopy. This disease kills something like 130,000 people a year."

The case for heart scans is even less clear-cut. Although CTs are sensitive in detecting calcium deposits on artery walls, the connection between these deposits and heart disease is still a matter of debate.

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