Bartecchi: Screening health scans – why?
Health screening is an important part of preventive healthcare. An early detection of a serious medical condition can be life-saving or at least help in managing a detected problem. Documented screening programs might include a periodic physical exam, different blood tests, blood pressure checks, certain cancer screenings (mammograms, colonoscopies, pap smears, skin exams, etc.), diabetic screening and other evaluations related to one’s age, gender and health history. Technological developments have gifted us with radiological scanning procedures, some of which have been suggested as valuable for health screening.
CT scans (CAT scans) combine a series of x-ray images taken from different angles around your body, and uses a computer to create slices of bones, blood vessels and soft tissues inside your body, providing more detailed information than plain x-rays might, though with some unwanted radiation exposure.
MRI uses magnets and radio waves to produce detailed images on a computer without using radiation. It can create images of nearly every structure and organ inside the body.
PET scan is an imaging test that can help reveal the metabolic and biochemical function of your tissues and organs, being able to detect both typical and atypical metabolic activity, possibly even before a disease becomes apparent on other scanning tests.
From the above discussion of the different scans, one can imagine how the uninformed might consider their value for disease screening. Early providers of these scans suggested that these scans could look into our insides and detect early warnings of cancers, cardiac disease and other abnormalities in healthy individuals with no symptoms of disease. However, the FDA found no evidence that whole body scanning in such individuals (using CT scans initially), provided more benefit than harm to the people being scanned.
Recently, those of us interested in medical screening programs were informed by TV star, Kim Kardashian, that she underwent a $2,500 full-body scan provided by Prenuvo, that can help “detect cancer and diseases such as aneurysms in their earliest stages, before symptoms arise.” She also noted that that there was no radiation involved. The Silicon Valley start-up company also claims that the scans are enhanced by their artificial intelligence (AI) tools. Wayne State University cancer specialist Gorski claims that the early whole body scans involved only CT scans and MRIs. Now, artificial intelligence has been added along with considerable cost. He notes the problems with Prenuvo, such as no published clinical trial results, no studies with controls, no understanding of the complications of using such screening tools and the vain hope that AI will eliminate or decrease the problems that were noted in old-fashioned whole body scans.
In April 2023, the American College of Radiology stated that it did not believe that there is sufficient evidence to justify total body scanning for people with no clinical evidence to justify scanning, such as clinical symptoms, presence of risk factors or suggestive family history of underlying disease, or that it is cost effective or effective in prolonging life. Livingston at Oregon Health Sciences U. feels that AI-assisted scans need to be exhaustively tested to make sure that they are accurate, reliable and actually improve patient outcomes and cause no harm. He feels that we are still a long way from that in medical imaging screening in asymptomatic patients. A recent review article by Ferryman et al. in the Aug. 31 2023 New England Journal of Medicine nicely points out how AI results can be distorted in radiological procedures. Researcher’s, however, do feel that once the problems associated with AI are resolved, it can be of value in providing more precise diagnoses and in shortening the waiting times for results. Sodickson from NYU School of Medicine suggests that (AI) can be used to cleanup MRI images.
Elmore, however, from UCLA School of Medicine feels that there is little scientific evidence that detecting lesions early with these scanning procedures is going to save lives. Another concern with these scans is that they can detect what are called “incidentalomas” or incidental findings that may never cause symptoms or require treatment, but could result in further testing, needless procedures and even surgery, all of which can result in complications as well as unnecessary treatments, significant expense and unnecessary stress.
New and effective scanning procedures, such as the PET-CT scan, are already available and able to provide faster and more accurate scans for the appropriate, symptomatic patient. Further studies of AI are in progress and are promising. It’s not difficult to imagine that at some point in the future, researchers will provide us with scans and AI tools that will give us the ability to detect disease processes earlier.
Dr. Carl E. Bartecchi, MD, is a Pueblo physician and clinical professor of medicine at the University of Colorado School of Medicine.
This article originally appeared on The Pueblo Chieftain: Bartecchi: Screening health scans – why?
