Are Women Being Scanned Or $cammed?

Searching for peace of mind, people are flocking to centers offering pricey (and perfectly legal) body scans. But what seems like a simple test could give you a false sense of security, even a higher cancer risk. Get the facts behind the hype.

Three years ago, I lost my best friend to lung cancer: Six weeks from diagnosis to death, and he was only 40 years old. It took months before I could cough without obsessing over Kevin's early symptoms, which he mistook for bronchitis. He had been a heavy smoker, and I worried that my pack-a-week habit through grad school might also have left a fatal calling card. I actually considered getting a lung X ray for my 40th birthday just to know I was clean.

This irrational fear of dying young is nothing new. Years earlier, in college, I once visited the campus health clinic because the right side of my abdomen seemed lumpy. A tumor? The doctor pressed on my stomach for a minute, then looked down at me with a bemused smile and said, "You're fine. You're just soft ."

There's a term for people like me: the worried well. We seem healthy, yet we can't shake the feeling our bodies are turning against us. Who can blame us for being paranoid? Hospitals and pharmaceutical companies hawk their goods on TV and radio, while some poor soul contracts a rare disease every week on Dateline or Lifetime. Maybe I'm overly impressionable, but people who aren't sick seem to be the exception these days.

Naturally, my ears perk up when I begin hearing radio ads for two local outfits offering computerized tomography scans to healthy people. They promise something my doctor can't: a simple, high-tech way to suss out latent signs of conditions from gallstones to clogged arteries to cancer. CT Screening International, with 13 centers on both coasts, features a fervent testimonial from a woman rescued from kidney cancer. Ads for the more evocatively named Imaging for Life (shades of Vanilla Sky ) tell me that "You could save a life. Your own."

Well then. Who wouldn't want to do that? A body scan sounds like a passport to peace of mind. (And because I'm adopted, it also seems like a good way to look for any inherited maladies that could be lurking.) I tell my husband I plan to get scanned. "Maybe you'll get lucky," he says dryly, "and there'll be something wrong with you."

The body-scanning phenomenon comes to us from Southern California, by way of Oprah Winfrey. CT technology was developed in the 1970s as a diagnostic tool; in the mid-1990s, a Newport Beach radiologist named Harvey Eisenberg, M.D., became one of the first to successfully promote scans as a screening measure for people with no symptoms of illness. When Dr. Eisenberg gave Oprah a full-body scan in October 2000, fans clamored to follow her lead, and scanning centers began popping up like latte joints.

Today, annual revenues at Dr. Eisenberg's center reportedly top $3 million, and elective body scanning has become an industry unto itself. In addition to established radiology practices, there are between 100 and 150 specialty operations tapping into the lucrative market of the worried well. Unlike conventional X rays, which produce one image of overlapping organs and tissues, CT scans offer a series of much more detailed cross-sectional images. Typically, a radiologist reads the results on a sophisticated desktop computer and walks you through them. Several days later, you get a written report and a CD-ROM of your insides, which will be forwarded to your doctor in the event that something suspicious turns up.

This kind of direct-to-consumer approach has become known as retail medicine—and as in all shopping, there are plenty of choices. The AmeriScan center at the Scottsdale Fashion Square in Arizona charges $960 for a full-body (at most centers, that means the neck to the pelvis) exam; clients peruse the Jimmy Choo pumps at Neiman Marcus next door while waiting for their same-day results, pagers in hand. At the other extreme, there's CAT Scan 2000, a company in Clearwater, Florida, that has six scanner-equipped semis trolling shopping centers and church parking lots in the South and Midwest. It charges a relatively discounted $567. Many centers also offer an a la carte approach: Vital Imaging, which has four locations in Southern California, charges $225 for an MRI of the neck (you never know what that pesky thyroid is up to) and $1,450 for a Women's Health Assessment Program that tests premenopausal women for osteoporosis, breast cancer and ovarian tumors.

I'm an ideal target for body-scan marketers: Roughly 55 percent of patients are women; at one major center, the average age is 44. My first foray into retail medicine comes complete with glossy, optimistic brochures, promotional pricing and sales tactics a time-share salesman would admire. I call CT Screening International first because its website touts the company's association with "recognized expert radiologists." The chipper "counselor" tells me the test costs $950, but if I bring a friend or mate he gets his at half price.

In the interest of comparison shopping, I dial Imaging for Life. The operator sounds annoyed as she answers, as if I've awakened her from a nap. The price is $50 lower, but I opt to go with CT Screening, because it can deliver my results in less time. I make a date for the next week at the Scarsdale, New York, office and promptly get e-mail confirming my appointment and urging me to purchase a virtual colon-oscopy at a "special cost when combined with other procedures."

"There are all kinds of things in the body we never see: Things we'll die with, not from."

Entrepreneurs selling body scans argue that their brand of free market medicine allows us to take charge of our health, circumventing heartless HMOs and harried personal physicians. "None of us is healthy," says Craig Bittner, M.D., a Johns Hopkins—trained radiologist who opened the first of his four AmeriScan branches in California and Arizona two years ago and plans to have 12 in all by year's end. "We're all losing bone density; we're all at risk for developing cancer, heart disease, stroke, aneurysm. The idea that there are two populations of people, some healthy and some patients, is ridiculous. We're all human beings that are changing inside, and we need to be proactive."

The medical establishment, however, isn't buying that line. The American Cancer Society, the American Heart Association and the American College of Radiology do not recommend elective full-body scans, and most insurance companies won't reimburse for them. The FDA, too, has never approved the use of CT scans as a screening tool (although their "off-label" use for that purpose is legal). There's no evidence that scanning people without symptoms is either cost-effective or life-prolonging, says Robert Smith, Ph.D., director of cancer screening for the American Cancer Society in Atlanta. A scan provides only a snapshot of the body's condition for one moment in time, he notes, yet a clean bill of health may reassure patients to the point that they neglect their health for years.

LUNG NODULES FOUND BY SCANS THAT TURN OUT TO BE BENIGN: 95% PERCENTAGE OF SCAN PATIENTS WHO ARE WOMEN: ABOUT 55 RADIATION DOSAGE OF A FULL-BODY CT: 400 TIMES A CHEST X RAY ANNUAL GROWTH RATE OF ELECTIVE BODY SCAN CENTERS: 100% COST OF A FULL-BODY SCAN: $570 TO $1,200

"We do not get X rays for peace of mind," Smith says. "We get X rays because we have a medical indication of a problem. You may get false peace of mind by having this very expensive test that seems superior to all the older, more medieval tests. But in fact, those tests may be more accurate at finding cancers, or anything else." Mammograms, for example, are far better for detecting breast cancer, and an electrocardiogram, blood-lipid profile or simple blood pressure test may reveal as much or more about the condition of your heart and arteries.

And what about when scanners do find something that concerns them—as happens anywhere from 10 percent of the time (at Dr. Bittner's clinic) to 80 percent (at Dr. Eisenberg's)? Nearly every center can cite individual cases of serious conditions caught by their screenings. "I don't think there's any information about your body that's going to hurt you," says Dr. Bittner. "To give people an understanding about their body is empowering."

But according to Smith, nearly all body-scan findings are false positives: harmless abnormalities such as cysts or nodules that may require sometimes painful and invasive follow-up tests. Small lung nodules, among the most common findings, turn out to be benign some 95 percent of the time, according to estimates. "There are all kinds of things in the body we never see unless we go looking for them," says Smith. "Things we'll die with, not from ." In a way, getting a body scan is like turning over a rock and discovering a snake: It might be harmless, but you may not find out until it bites you. In some cases, it's best left alone.

Just ask Cynthia Hubert. Last year, the 41-year-old newspaper reporter was given a scan gratis at Radiological Associates of Sacramento, California. Twenty minutes after the test, the chief radiologist arrived to give her a guided tour of her body. Everything looked good; then he got to the kidneys. "All of a sudden he said, 'Uh-oh. This shouldn't be here. It might be a small tumor,'" Hubert recalls. "That's a pretty scary thing to hear. Then he just kind of moved on to the pancreas." Hubert's personal physician recommended an MRI using a high-contrast fluid pumped into Hubert's arm with an IV, which would show a clearer picture of the kidney "splotch," as she calls it. Her insurance company covered the bill for the follow-up. "The radiologist on the scene said immediately she felt it was nothing, a benign cyst," says Hubert. "That MRI probably was not necessary, and those are pretty expensive tests."

A false positive is a small price to pay for peace of mind, says Peggy Wagner, a spokesperson for Radiological Associates of Sacramento. "Sometimes follow-up exams prove that the area in question is of no real concern. But sometimes it is."

Kenneth H. Cooper, M.D., founder of the Cooper Clinic in Dallas and a pioneer of preventive medicine, blames soaring false-positive rates in part on inadequately trained and inexperienced medical personnel. Dr. Cooper, who has performed some 35,000 whole-body scans on clients who come to his wellness center, says the tests have "tremendous potential" if they are incorporated into a complete examination, including stress testing and blood studies, and as long as the company that performs them is associated with a hospital, university or reputable clinic. "If you have highly qualified people who are interpreting results, it can be a valuable tool," he says. "But right now a businessman can buy one of the pieces of equipment for $2 million, put it in a shopping mall and hire any nurse or technician to run it. And unless they can analyze the data in a sophisticated way, the poor patient doesn't get any benefit."

While the number of independent scanning centers doubles each year, their safety and quality are not closely monitored in many states. The FDA has no inspection program to judge the competence of technicians at scanning centers, and training requirements vary from state to state. According to Christine Lung, director of government relations for the American Society of Radiologic Technologists in Albuquerque, New Mexico, 12 states do not license or regulate those who perform medical-imaging exams, and four others have weak laws. In those 16 states (Alabama, Alaska, Colorado, Georgia, Idaho, Kansas, Michigan, Missouri, Nevada, New Hampshire, North Carolina, North Dakota, Oklahoma, Pennsylvania, South Dakota and Wisconsin), people can be hired to perform medical-imaging examinations after as little as six hours of training or can even be trained on the job.

The lack of standards worries some leading radiologists, who know that the amount of radiation you're exposed to during a scan depends on the proficiency of the technician administering it. The effective radiation dose received during a typical CT screening equals roughly 400 chest X rays, an amount "not very different from that which has been shown to result in increased cancer in atomic bomb survivors," says Thomas Shope, Ph.D., a radiation physicist at the FDA's Center for Devices and Radiological Health. As a result, getting an annual scan may eventually raise your risk for the very cancer you're trying to root out.

Proponents say that CT scans have been given since the 1970s without any proof they cause harm and that a skilled technician can keep radiation low. But Shope maintains that even a single whole-body scan poses a small but not insignificant danger—and that each scan increases your risk of developing cancer. If you followed some scan centers' recommendation that "high risk" people (heavy smokers, for example) get annual scans beginning at age 40, you would increase your risk 10 times by age 50. Imagine if you started younger. I called half a dozen scanning centers around the United States and asked the operators how old you should be to get a whole-body scan. The answers ranged from "anyone over 21" (AmeriScan) to "no one under the age of 25" (Health View Center for Preventive Medicine) to "I'm 36, and I did it!" (Virtual Physical).

Two nights before my own scan, I can't sleep. What exactly have I been sold? And do I really want to know what my body is hiding? The next morning I call CT Screening and cancel. My counselor is not pleased. "I see you've already rescheduled once," she says. "Dana, it's time to take affirmative action for your health!" As extra incentive, she knocks 10 percent off the price. Nobody scolds me and gets my money, so when I work up my nerve to reschedule the scan a few days later, I go with Imaging for Life, which has two locations, both in the New York City area.

When I show up for my 9 A.M. appointment at the White Plains, New York, branch, there's one other person in the waiting room, a woman about my age who is the picture of glowing, affluent health: long, thick, lustrous hair, Burberry purse and sneakers, a serious offseason tan. The receptionist gives me a clipboard, and I fill out the paperwork while a segment on women and heart disease plays on the Today show. A technician in surgical scrubs hands me a tall glass of white liquid that, she quips, "tastes like a cheap ???pina colada." It's a barium solution that will make the image of the intestines clearer.

The CT machine, a narrow bed with a large tire-shaped portal at one end, occupies a room the size of a studio apartment. I lie down on the bed, and it moves me under the machine as if I were a suitcase being screened at an airport. From behind a plate glass window, the amplified voice of the technician directs me to hold my breath at intervals—20 seconds to scan the lungs, 20 seconds for the heart, 40 seconds for my whole body. The entire experience takes about 10 minutes. I'm told a doctor will call within 48 hours with my results. I don't sleep that night, either.

When I answer the phone the next day and the caller identifies herself as Dr. Mary Chappell from Imaging for Life, a shiver shoots up my spine. But she defuses my anxiety immediately. Things look great, she tells me: liver, kidneys, spleen, adrenal glands, pancreas, thyroid gland, all normal. My bones are appropriately dense. My lungs, chief source of my anxiety, are "nice and clear." And my coronary arteries are as clog-free as the Holland Tunnel at 3 A.M. A few days later, I receive a detailed report written in confusing medical jargon ("There is no infiltration of the intrabdominal [sic] or pelvic fat") and a copy of my scan on a CD-ROM that doesn't work on my Macintosh. How wonderfully, marvelously anticlimactic.

As the afterglow of my spotless bill of health fades, however, I realize the scan has given me only a partial picture of my overall condition. Mentally, I check off the myriad diseases that scanning can't scope out. Diabetes, hypertension, lupus. Certain afflictions of the brain, including Alzheimer's, and the blood. The list is endless, and before long I'm back where I began, worrying about symptoms I don't have. It occurs to me I could make a full-time job of anticipating my own death, when what I really ought to do is avoid cigarettes, eat my greens, get enough sleep, exercise more than intermittently, get an annual mammogram and a Pap smear (both a fraction of the cost of a body scan) and keep my fingers crossed. Who knows? With my luck, I'll live to be 90.

Dana White lives in Ossining, New York. Additional reporting by Ann Farmer.