Should you get a full-body "screening" CT scan?

There are various "executive health" programs that advertise that you can get a full-body screening CT scan. If you have a lot of money and your company is willing to pay for expensive (and often unnecessary) medical diagnostic tests, then maybe you're considering the utility of a screening CT. Not me.

Why expose your body to unnecessary radiation? Why risk finding an incidentaloma (which may then lead to further tests, biopsies, procedures, etc.) that might end up being nothing? Why do something that is outside of the scope of routine health screening guidelines?

I understand that large corporations may feel the need to go above and beyond to examine and maintain the health of their key executives. Many companies won't allow a large group of their executives to fly on the same flight. Should an airplane crash, they don't want to lose all their key people. So, they end up staggering people on different flights.

Increasing confusion about mammograms

Everyone is getting confused about mammogram guidelines. The U.S. Preventive Services Task Force (USPSTF) recently came out with new guidelines and these cancer screening recommendations are quite different from those published by the American Cancer Society (ACS). Now, the Senate is dealing with amendments of amendments. What do I mean by that? There was an amendment by Mikulski. Then, there was one by Vitter. Then the Murkowski amendment got rejected (I'm not sure if all this chronology is correct, but I think you get the picture). Soon, we won't remember what the original amendment said.

So what's with all these amendments? One key question is: how will insurance plans (including a possible public option) pay for screening mammograms? Who will need to pay a copay? What is the appropriate age to start breast cancer screening? 40? 50? How often should women get a mammogram?

I've heard some people argue that the USPSTF came up with these revised guidelines to reduce the number of mammograms the government would need to cover under the proposed public option. Does this make sense? Well, if the government can find a way to reduce health care costs, it would be to eliminate expensive tests. A mammogram isn't super expensive, but if you could stop all those women who are ages 40-49 from getting a mammogram, you would save a huge amount of money.

Are screening guidelines published to save costs or save lives? Where do you draw the line to declare that a screening test is indeed "cost effective?" How is that term even defined? At this point, I think that most of us have more questions than answers.

Wait until 50 for mammograms

We seem to make cancer screening recommendations only to realize that we are wrong. Breast self-exams are not beneficial so we should not be telling out patients to do them. Mammograms should start at age 50, not 40. False positive results end up leading to further unnecessary tests, biopsies, etc. However, what about those few people who get diagnosed with breast cancer early? At what point is screening "cost-effective?" That's a critical question since screening tests cost money.

So, who do we follow? The U.S. Preventive Services Task Force (USPSTF) or the American Cancer Society (ACS)? Who's right? Could they both be right?

As these issues are debated, patients and health care professionals will be left confused. Without the presence of a clear consistent message, people will be left to interpret things for themselves and we will end up with chaos.

Breastlight and Breast Self-Exams

Medgadget has a story on a fancy flashlight-type medical device called the Breastlight. It shines a light through breast tissue so that you can almost see inside your breasts and look for suspicious areas that might suggest breast cancer. This device is produced by PWB Health Ltd out of Dumbarton, UK, and was developed by Highland Innovation Centre (Inverness , UK). Looks like a very interesting product, but I wonder if it will do more harm than good. What do I mean by that? Well, let's consider what's happening in the world of breast self-exams (BSEs). Are BSEs even recommended these days? Let's see:

• The 3rd US Preventive Services Task Force (USPSTF) concluded that there was insufficient evidence to recommend for or against BSEs. That's very helpful.
  
• In 2003, the American Cancer Society (ACS) changed its previous recommendation in favor of monthly BSE to a recommendation that women be educated about the benefits and limitations of BSE by their healthcare provider. Once again, that's very decisive, isn't it?
  
• The American College of Obstetricians and Gynecologists (ACOG) recommends that healthcare providers routinely teach patients about BSE.

So, we should all teach patients about BSE, but should we be telling them that it's helpful or that it's harmful because it may lead to false positives and more invasive tests? Do BSEs really reduce mortality caused by breast cancer? What about other countries doing?

• The Canadian Task Force on Preventive Health Care concluded that "there is fair evidence to recommend that routine teaching of BSE be excluded from the periodic health examination of women aged 40 to 49 (grade D recommendation)" because of excessive work-ups for false-positive examinations and lack of firm evidence that BSEs decrease breast cancer mortality. Now, we finally have someone taking a stand instead of straddling the fence!
  

• The Advisory Committee on Cancer Prevention in the European Union states that there is "no convincing evidence for the effect of screening based on breast self-examination or clinical breast examination."
  

So where does this leave us on BSE? How will this new Breastlight impact breast cancer screening? I don't suggest that you share this device with hypochondriacs. To read the full article, click here. Image source: Medgadget