Jill Broffman, M.D.

Introduction

Despite the lack of scientific evidence, thousands of patients have had total body scans. I have observed a steady increase in interest in total body scans from my patients. Before last year, only one or two patients per month inquired about the test. The number has steadily increased to as many as four patients per day, but most patients elect not to have the scan following the discussion. Nearly all of my patients followed up with me only after having had the scan. Here are some cases.

Case One

A 46-year-old woman had a total body scan because she feared cancer. She was adopted and did not have a family medical history. She had well-controlled GERD, two episodes of shingles at two different sites, mild PMS with chronic pelvic pain, fatigue, depression, obesity, and led a sedentary lifestyle. She had recently become physically active with marked improvement in mood, diet, weight loss, and pains until she injured her lower back which caused recurrent depression and illness. Her screening tests were up to date, but her total body scan revealed large masses in her breast and ovary. Ultrasound diagnosed a probable dermoid cyst and complex breast cyst. She had a total abdominal hysterectomy and BSO due to chronic PMS symptoms with pelvic pain and a negative breast biopsy. Her back and sciatic pain had slowly improved, and she had resumed a moderate exercise program.

Case Two

A 34-year-old male with a history of seizures was offered a free total body scan when his wife, a TV journalist, interviewed the director of the total body scan facility. Unexpectedly, the results indicated severe osteoporosis of the spine, with a T score of -

3.45. The patient and his wife were very upset by the findings and called immediately. A DEXA scan was performed, which reported a LS spine T score of +2.0 and a total hip T score of +2.3. They were very relieved by the normal DEXA results.

Discussion

Many of my patients have asked about total body scans but only a handful (approximately 20) has actually taken it. When asked why they were interested in the scans, nearly all patients reported cancer screening. Only two patients stated heart disease and one for an abdominal aneurysm as the reason for undergoing the body scans. A few patients felt "it was good to be screened for everything." Most are healthy, young patients in their late 30's or 40's. Several are smokers or have a relative or close friend with cancer causing anxiety about their own health. A few patients are in the 50's and 60's with or without chronic medical conditions, although most are healthy.

Total body scans by electron beam computerized tomography (EBCT) offer patients a quick and painless assessment for heart disease, cancer, and osteoporosis.^1,2,3 This scan is heavily promoted as a comprehensive screening test capable of detecting occult disease in asymptomatic patients much earlier than the physicians, labs, and tests routinely performed each year. Such pre-clinical detection could potentially reduce the morbidity and mortality from the leading causes of death in the United States: coronary artery disease and cancer.^4,5 The pre-clinical detection could potentially save lives by enabling early intervention, enhancing therapeutic efficacy and response, preventing complications and progression of disease, and improving quality of life.

Advertisements on television, radio, and in newspapers appeal directly to the public using testimonials from patients claiming that EBCT saved their lives: a 58-year-old asymptomatic male with a low HDL level scheduled an EBCT heart scan to determine if he had coronary artery disease.⁶ At his appointment, he decided instead, to have a total body scan which demonstrated clean coronaries as well as a small malignant renal tumor. The patient was cured following nephrectomy alone, a rare outcome for a cancer that is usually diagnosed in more advanced stages. Celebrity clients also endorse the test because of their experiences. An abnormal result may have enabled early detection, effective treatment, and prevention of complications. Conversely, a normal result provided them with immeasurable reassurance and peace of mind. These advertisements appeal to a majority of the population including the health-conscious healthy patients, the average "worried well," the depressed or anxious patients, as well as those with known risk factors for and/or who have chronic diseases. Case reports emphasize that seemingly healthy asymptomatic people may actually have a serious, undiagnosed illness.⁷ This may cast a doubt in many patients' minds about their health, cause anxiety, and promote testing. Patients who suffer from depression and anxiety may seek testing for common, depression or anxiety related symptoms (fatigue, malaise or pain) because they are concerned about a potential underlying medical disorder.

There are approximately 65 EBCT scanners in the United States. California has the most scanners with five in Los Angeles (as of 1999). The costs of these scans can range from a few hundred dollars to a thousand dollars or more.⁸ An increasing number of radiology, university, and specialized centers are offering total body scans in response to consumer, not medical, forces. No scientific studies are available to support total body scans as routine screening tests, and The American College of Radiology and cancer societies strongly discourage its use.⁸ However, EBCT of specific organs have been studied and may be useful for specific patient populations at risk, such as coronary calcium scores determined by heart scans, lung cancer screening in smokers or virtual colonoscopies in family members of colon cancer patients. Whether any of these tests can reliably detect early disease and effectively reduce mortality remains to be seen.

The total body scan is gaining public attention and support as a valuable screening test for cancer and heart disease. Conversely, the FDA, radiology, and cancer societies and a majority of physicians are skeptical. Limited data, lack of scientific studies, and risk of unnecessary tests and worries are important issues to discuss with patients considering these tests. Research studies are needed to evaluate these concerns and guide the appropriate use of EBCT for total body scanning.