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Ready for a Close-Up

Full-body CT scans offer a chance to spot problems before they become serious. But critics charge they're expensive, not particularly useful and may cause unnecessary anxiety.

February 26, 2001|BENEDICT CAREY | TIMES HEALTH WRITER

The good life is what brought David Clark to the Beverly Hills 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 in Santa Monica. "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 of 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, a Marina del Rey executive 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 at Parkview Imaging in Santa Monica and Healthview Center for Preventive Medicine in Newport Beach, 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 from Santa Monica, whose InsideTrac scan found a 3 1/2-centimeter node on his left kidney. Stone had the kidney removed, and doctors confirmed the lump was cancerous. "I've had no spreading, no lymph node involvement, no chemotherapy, nothing. And I'm fine. I think the full-body scan is one of those things you can't afford not to do."

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 that 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 USC 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. "CT scans of the lung, colon and heart are the three tests that are the most thought-out," says Dr. Sanjay Saini, director of CT services at Massachusetts General Hospital, "and you must look at each one separately."

Usefulness Differs According to Risks

The first thing to know about lung cancer is its predominant risk factor: smoking. Many radiologists consider CT scans a good idea for people who have smoked about a pack a day for 10 years. "I recently did one for my father, who has smoked for many, many years," says Saini. "You get much better images from a CT scan than you do from a chest X-ray."

In a recent study of 1,000 longtime smokers, for instance, doctors found that 233 had a nodule on their lung scan that looked like it could be cancerous. Further scanning picked up 27 that were malignant, only seven of which showed up on chest X-rays.

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