[ RadSafe ] Scanning craze may do more harm than good

[Dawson, Fred Mr]

Scanning craze may do more harm than good to the wealthy but worried

Times reports 
http://www.timesonline.co.uk/tol/life_and_style/health/article3031545.ece

Screening procedures being offered to thousands of Britons by private health insurers may be doing more harm than good, experts say.  The Department of Health has launched an inquiry to assess whether health MoTs involving whole-body scans offer benefits that outweigh radiation exposure risk. The Committee on the Medical Aspects of Radiation in the Environment (Comare   http://www.comare.org.uk   ) is to publish a report next week calling for greater regulation of companies that promote screening tests. More people are undergoing the check-ups, which private clinics say can identify problems early.  Yet some computed tomography (CT) scans can deliver a radiation dose equivalent to 500 chest X-rays, and ministers are said to be concerned about giving such high radiation doses to people who have no symptoms.  The report, commissioned by the Government, will examine the risks and benefits of CT scans, which are widely advertised to help to diagnose lung and colon cancers, or to look for abnormalities in a whole-body scan. Several private clinics are offering the scans for up to £3,000 each.  Nicholas Wald, president of the Medical Screening Society, said that insurance companies were overusing the tests, which could also cause anxiety over uncertain results. A code of practice is needed to ensure the tests are only done when absolutely necessary, Professor Wald said. CT scans represent about 6 per cent of the X-rays in Britain, but are responsible for 40 per cent of radiation exposure. The estimate is that a dose increases the risk of cancer by about 1 in 2,000.  But the procedures, also used to assess the risk of heart attacks, do not help in ruling out disease, Professor Wald said. There have not been enough trials to show that either CT scanning of the heart, or colonoscopy, are of benefit. Writing in the Journal of Medical Screening, he adds: "There is, emerging in Britain, a culture in which judgments on medical screening practice are being made in the absence of evidence. The culture needs to change." Outside he established breast and bowel cancer screening programmes, it is hard to say how many scans are being carried out in private clinics, Professor Wald said, but those offered by companies such as Saga Insurance have not been shown as worthwhile.  Someone having a one-off full-body CT screening has an estimated cancer death risk of about 1 in 1,200. An annual scan for 30 years increases this risk to almost 1 in 50, according to research in the journal Radiology.  The net benefit of finding cases of disease through screening could be reduced by about half after potential deaths from radiation or surgery are accounted for, a separate study suggests. Doctors also complain that they now have to spend more time reassuring the "wealthy worried well" about inconclusive results, he said. In a report last year, the British Medical Association said that scans could pick up abnormalities that were only found to be benign after patients had had further tests or surgery. Trials in the US and Europe will discover whether CT scans are worthwhile. The scanning clinics said that in 2 to 3 per cent of those scanned, some life-threatening abnormality was found. But in one US study of 1,200 body scans, nearly a third of patients were advised to have further tests, most of them unnecessary.  Gill Markham, vice-president of the Royal College of Radiologists and a member of the Comare medical practice panel, said there was a "growing momentum to bring the industry under control". But Steve Ashton, of Saga, said: "We have had thousands of customers who are extremely happy that they had the scans and found things they did not know existed." 

Health check 
1 in 1,200 chance of cancer from one-off radiation dose of full-body CT scan 
3% of patients have life-threatening problem uncovered (estimate) 
33% of patients are told to have further investigation or checks 
100,000 men and women have a private healthcheck with BUPA each year 
Source: Saga; BUPA, Times Database 

Fred Dawson 
Fwp_dawson at hotmail.com