Diane Kelsall is Deputy Editor, clinical, at CMAJ, and Editor of CMAJ Open
In the newspaper, today, I found a bright gold flyer with a dire warning—and some hope. The flyer told me that heart disease, stroke and cancer are “the three leading causes of death in America!” The hope? In bold letters, the flyer proclaimed that
“A BODY SCAN Can Save Your Life!”
It told me that medical experts agree most heart disease, strokes and cancer can be prevented if detected early. And, lucky me, the US clinic was offering “painless, safe” colour ultrasound with no blood testing and no needle injection!
I could have everything from a “heart scan” for US $150 or “stroke scan” for $60 to an ultrasound imaging of my deep leg veins ($60) to find those pesky blood clots that may be lurking. They were even offering ovarian and uterus scans for $60 (which seemed to be the going rate for most of the 11 scans) to detect masses and cysts that apparently could lead to ovarian cancer or uterine cancer. For $500, I could have all the scans and reassure myself that my arms and legs had decent blood flow and that my gallbladder was cancer- and gallstone-free. They also offered two other packages: the Heart/Stroke scan and the Cancer/Organ scan.
In small letters at the bottom of the page, the flyer mentions that Medicare will not cover preventative scans at this time—which led me to think that Medicare was sitting in its office in Washington, mulling over the pros (there could hardly be cons, could there?) of providing full body scans to the entire US population.
The fact is that there is no evidence that full body scans save lives on a population basis. Full stop. Not only do they not save lives, the scans may show a small lesion that we as physicians are obligated to investigate, often with those very blood tests and needle injections that the authors of this flyer reassure me are NOT part of the scans. And these investigations may not be limited to a simple blood test. Sometimes, much more invasive procedures, with their accompanying risks to health, are required to determine whether the lesion is or is not something we should be worried about in the long run.
Of course, everybody knows somebody who had their life saved when [ADD CANCER/ANEURYSM/RARE LIFE-THREATENING MEDICAL CONDITION HERE] was found incidentally when they had [ADD INVESTIGATION HERE] for another problem. But that, my friends, is an n of 1. And that is not a good reason to subject countless others to important health risks related to unnecessary investigations.
So, to the authors of this flyer, I say NO to your kind offer. I’ll take my chances instead—with preventive care supported by evidence.