How Perils Can Await the 'Worried Wealthy'

By JANE E. BRODY

ordes of consumers, often called "the worried wealthy," are flocking to medical centers and mobile trailers around the country to have their bodies scanned by three-dimensional computerized X-rays from chest to groin.

They are not sent by physicians, and most have no symptoms to warrant exposing themselves to radiation doses that may add up to the equivalent of 500 chest X-rays, the National Radiological Protection Board says.

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Rather, these anxious consumers are spending many hundreds of nonreimbursable dollars on total body C.T. scans to reassure themselves that nothing is wrong internally that would warrant prompt treatment.

The scans are advertised as report cards for the body, uncovering potentially deadly diseases in time to save a life or offering hopes of longevity to the healthy.

But can these scans provide the peace of mind that patients seek? And are patients prepared for the follow-up exams needed when the scans reveal abnormalities that, more often than not, turn out not to present any health threat?

No Proof of Value

I will start with the bottom line, neatly summarized by Dr. Mary Hufty, who leads a committee on prevention guidelines for the Palo Alto Medical Foundation: "A negative total body C.T. scan does not provide reason to feel reassured, and a positive C.T. scan does not provide information that has been shown to improve life expectancy or quality of life."

Although promoters of scans cite a number of positive results — patients found, for example, to have a symptomless kidney cancer — no one has yet published any study to document the value and safety of the scans for ostensibly well people.

The lure of body scans is easy to understand. The test is noninvasive. It involves lying in a machine that takes high-resolution X-rays of hundreds of slices of the body and reassembles them into an X-ray film that is interpreted by a radiologist.

But C.T. scans were never meant to be screening tools. They were developed to serve as aids in diagnosis, not blind searches for what may or may not be wrong with a patient.

When the scan is used properly for a patient with unexplained symptoms, for example, persistent abdominal pain, the radiologist knows what to look for that may account for the discomfort. But when a scan is done on someone without any symptoms, the radiologist has no clue what to look for and may find aberrations that are of no consequence but that nonetheless must be examined further.

In a report in May (on the Web at nytimes.com /health), my colleague Gina Kolata described the fate of an Atlanta physician who chose to have a "virtual colonoscopy" — a C.T. scan of the colon that searches for polyps where colon cancer may arise.

The doctor's colon appeared normal, but the scan revealed lumps on his liver and a kidney along with multiple nodules of the lungs. A second scan, using a dye, showed the masses on the kidney to be innocuous cysts, found in half of the people over 50. But the liver mass necessitated a biopsy, and examination of the lung nodules required surgery that involved collapsing the lung.

Medical bills totaled $47,000, and it took eight weeks for the doctor to feel normal again, all to learn that both the liver and lung masses were nothing more than scar tissue caused by an old fungal infection.

Although the scans themselves are rarely, if ever, covered by medical insurance, when an abnormality is suspected, insurance often pays for the follow-up tests and exploratory surgery, a bill that ultimately gets passed on to everyone with medical insurance.

False positives, which the Atlanta physician had, are common when scans are used for screening instead of diagnosis. As Dr. Solon Finkelstein, a radiologist at the Palo Alto Medical Foundation, pointed out: "Most people have some nodules in their lungs. Most are benign and not cancerous. They are often the result of old disease, such as a scar from an old infection. The C.T. scan is not finding things that are not there, but finding things that may not be significant."

His colleague Dr. Hufty added, "The many false-positive results produced by total body C.T. scans can lead to tremendous anxiety and unnecessary operations and testing."

But what if the findings of a body scan are negative? Doesn't this mean a clean bill of health? Not necessarily, say many experts. "Many things can be amiss that are not shown on a C.T. scan, such as infectious, hematological, metabolic or endocrine abnormalities," Dr. Hufty said.

Patients with negative body scans may think they do not have to undergo other well-established preventive medical exams, like Pap smears and colonoscopies.

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A virtual colonoscopy may find polyps, but they cannot be simultaneously removed and biopsied, as they can in an ordinary colonoscopy.

Keep in mind, too, that a scan of the torso does not cover the entire body. Something may still be wrong in the head or limbs that will not be detected but that may be suggested in the course of a standard medical checkup.

Finally, there is the concern about the amount of radiation involved in a total body scan, a level that is even higher if a virtual colonoscopy is also done. Radiologists point out that radiation doses are cumulative; the higher the total dose received over a lifetime, the greater the risk of a mutation that could result in cancer.

Furthermore, as Maryann Napoli, associate director of the Center for Medical Consumers, a watchdog agency in New York, said: "The original C.T. scanning equipment came on the market before 1976, when the Food and Drug Administration first began requiring proof of safety and efficacy for medical devices. There is no requirement for the manufacturers to prove their equipment is safe and effective for this new use."

Do They Ever Help?

Yes, indeed, sometimes a total body scan on a symptomless person turns up a problem that, if not corrected, may eventually become a fatal disease. Those patients are convinced that the scan was the best investment they ever made.

But the same problems may have been found in the course of a regular physical exam, also soon enough to result in a cure.

For example, at the Cooper Clinic in Dallas, where thousands of healthy patients have been screened, 25 kidney tumors were found through C.T. scans on nearly 12,000 consecutive patients, the institute reported last year. That is one tumor among every 480 patients. Most of the tumors would probably have been felt by a physician in the course of an exam.

A special scan of the heart may reveal dangerous blockages that escaped other noninvasive exams. Stories of men who have had heart attacks within weeks of passing exercise stress tests are legion.

For a heart scan to be cost-effective with a reasonable benefit-to-risk ratio, however, cardiac specialists say that at the very least the patient should have one or more risk factors for heart disease or a strong family history of premature heart disease.