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    9 April 2005

    Whole-body CT screening

    A whole-body CT screening centre has been in operation at a town near mine, part of a chain called Lifescan. Patients pay between £300 (for a lung scan) and £750 (whole body CT with virtual colonoscopy) for CT scans to screen for unsuspected disease. Anything that is found that might possibly be significant then needs to be followed up. Sometimes early, unsuspected cancer is found . But often, the abnormalities turn out to be insignificant and of no consequence.

    This ends up being very expensive, and a team from the Massachusets General Hospital concluded that CT screening was not cost-effective.
    Cost-Effectiveness of Whole-Body CT Screening
    Beinfield, Wittenberg, Gazelle, Radiology 2005 Feb;234:415-422

    If the patient pays directly, this is not too much of a problem (at least for the health care providers), but medical insurers do not cover CT screening, and in many countries, the state ends up bearing the cost.

    Here is what others have said:

    Prof Adrian Dixon of Cambridge University, Warden of the Faculty of Clinical Radiology (the Royal College of Radiologists)
    Another topical issue is the question of walk-in screening centres offering to "save lives" by whole-body CT screening, sometimes for profit. In the UK, the National Screening Committee has suggested that the National Health Service should not offer such screening at present (Muir Gray, personal communication). Many sources suggest that a radiologist's private practice should mirror their NHS practice. The current radiological and radiographic workforce can barely cope with the existing workload, let alone such new ventures. It will be interesting to hear what other countries recommend. Several observers have noted that such walk-in centres are usually located in relation to educated health-conscious consumers who can afford such procedures! ....... Hard facts from primary research are urgently needed. But I cannot see too many grant giving bodies rushing to assess what is currently viewed as a somewhat opportunistic and entrepreneurial endeavour.
    Whole-body CT health screening.
    Dixon AK. Br J Radiol. 2004 May; 77(917):370-1

    A group from the Mayo Clinic
    CT screening for lung cancer offers the possibility of reducing mortality from lung cancer. Our preliminary results do not support this possibility and may raise concerns that false-positive results and overdiagnosis could actually result in more harm than good .....
    Our data do not suggest a mortality benefit; whether CT for lung cancer meets the criteria for an effective screening test remains to be proved .....
    Our preliminary mortality results should cause physicians to pause and reexamine their positions if they are performing routine CT screening outside of a clinical trial.
    CT Screening for Lung Cancer:Five-year Prospective Experience
    Swensen et al. Radiology 2005 April ;235:259-265.

    A group from Stanford (with regard to the situation in the United States)
    Direct-to-consumer marketing of self-referred imaging services, in both print advertisements and informational brochures, fails to provide prospective consumers with comprehensive balanced information vital to informed autonomous decision making. Professional guidelines and oversight for advertising and promotion of these services are needed.
    Advertising, Patient Decision Making, and Self-referral for Computed Tomographic and Magnetic Resonance Imaging
    Illes et al. Archives of Internal Medicine, December 13, 2004; 164(22): 2415 - 2419.

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