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Peace of mind -- but at a price

Elective CT scans are gaining popularity despite their cost and some concerns that they may do more harm than good.

September 01, 2003|Daniel Costello | Special to The Times

FIT, tan and significantly younger-looking than his 57 years might suggest, Garret Leahey still worries about the perils of getting older. Is he really as healthy as he thinks? He's heard the horror stories, especially the guys who eat right, run every day and then have a heart attack during a jog in the park or while playing basketball with their kids. "I know things can change on a dime," he says flatly.

So two weeks ago, the Los Angeles man decided to do something about it: He got a full-body CT scan. Cost: $800, all out-of-pocket.

Since arriving on the scene just a few years ago, elective CT scans -- essentially powerful, computer-aided X-rays once reserved for sick or high-risk patients -- have exploded in popularity with throngs of worried well who need to know they are OK. The number of CT scans reached 32 million last year, up 6 million since 1997, with a significant chunk of that gain coming from elective tests.

"This is fast becoming an integral part of people's annual medical regimen," says Bruce Friedman, president of Heart Check America in Los Angeles, where Leahey underwent his procedure.

Still, many doctors and medical associations balk at the trend. The Food and Drug Administration, the American Cancer Society and the American College of Radiology recommend against the exams for patients without symptoms. Many physicians say self-referred screenings aren't worth the money, especially because most insurance companies won't pay for screenings on a preventive basis.

Many also fear that elective scan results are riddled with false positives that lead to needless anxiety and possibly dangerous follow-up procedures.

Scan proponents often paint critics as little more than scaremongers, pointing out that the scans can detect problems other exams may miss. But a small and growing body of research seems to support some of the critics' concerns.

Recent studies have shown that although more than a third of the people who get scanned find something abnormal enough to require a follow-up, as few as 1% ultimately discover anything meaningful. Other research validates different fears, such as high radiation exposure that in some cases can reach 250 times the level of a typical chest X-ray. Several states, including Texas and Pennsylvania, have passed laws banning patients from getting scans without a doctor's referral.

"People see this like it's 'Star Trek,' where we can take a swipe of a wand and find what ails them -- then another wand and fix them," says Dr. Robert Smith, director of cancer screening at the American Cancer Society. "That isn't the case. We are increasingly seeing the benefits of these tests don't warrant the costs."

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Scan centers on the rise

Even in tough economic times, the trend shows no sign of slowing.

Although some centers have encountered financial problems -- with some even closing their doors -- experts say that's primarily because they expanded too quickly. Overall, the number of centers has continued to increase.

Southern California has an estimated 30% of all scan centers in the country. Radio commercials and print ads -- "These 15 minutes could save your life" -- abound. It's also hard to ignore the sometimes-startling results.

Beth Henson, 56, of Camarillo, got her first full-body scan last summer. Since turning 50, she has tried a new test every year, including a bone density exam and an AIDS test. All turned out fine. But in her CT scan, doctors noticed that one of her ovaries was the size of a grapefruit, something her own doctor later said was impossible to detect with a typical pelvic exam. Henson had surgery, which showed that the growth was precancerous. She had her ovary removed and now says she is fine.

"All I can say is that this was worth its weight in gold for me. I believe it saved my life," says Henson, who has recommended the test to many of her friends.

Elective CT scans initially were limited to the heart. But a major study, published in 1999 in the prestigious British journal Lancet, showed the positive benefits of scanning for early lung cancer -- a major killer. That, and public endorsements by celebrities such as Oprah Winfrey and Isiah Thomas, further ignited the industry. Soon companies began offering scans for more areas of the body including tests such as virtual colonoscopies and brain scans.

The scanning centers themselves fall under few regulatory guidelines. The FDA has approved the use of CT scanners for diagnostic use, but not for screening purposes. That means companies are using the machines "off label." As long as they don't include the names of specific machines in advertising, even the most erroneous claims are hard to stop. Still, proponents contend CT screens are going through the same struggles and criticism other screening technology had to endure before receiving broader approval.

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