Opinion: Body scans miss the mark when it comes to improving disease prevention : Shots

Consumers are paying cash for preventive health testing with full body scans, which typically use MRI technology.

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The websites are tantalizing: “You can catch conditions before they become crises,” reads one. Another promises to make cancer “easier to beat” and claims it can detect “over 500 other conditions in up to 13 organs.” Full-body scans are attracting celebrity promoters, tech mogul investors and long waiting lists of people hoping to identify life-threatening conditions, usually more treatable in early stages.

Now offered by private companies in over a dozen U.S. cities, the scans commonly rely on magnetic resonance imaging (MRI), supported by artificial intelligence, to assess major organs for hidden disease. The scans, which are not covered by health insurance, take about an hour. They are then reviewed by radiologists before results and suggested next steps are shared with the customer.

Although I’m a believer in the power of prevention, I’m not taking the bait.

I’ve spent much of my 22-year career as a family doctor counseling patients on the benefits of screening for cancer and other chronic diseases, ordering appropriate tests and vaccines, and evangelizing about a healthy lifestyle. But this new race to sign up for full-body scans is troubling, given the scant evidence of benefit and the high price tags (as much as $2,500).

Instead of focusing on the dubious potential of these new scans, our nation should recommit to reaching everyone with established prevention strategies known to save lives.

Missed opportunities

Decades of research prove that regular screenings reduce illness and death. Age, risk and sex-based recommendations include testing for colon, breast, cervical and lung cancer; blood pressure checks for hypertension; and bone density tests for osteoporosis. Children need regular well-visits. Vaccines are available for everyone to prevent infections.

Thanks to the Affordable Care Act, most health plans now cover preventive services without cost-sharing by patients (i.e., copays and meeting deductibles).

Yet, according to Healthy People 2030 — a federal initiative to increase rates of preventive health care — only 5.3% of adults ages 35 and older in the United States received all recommended high-priority clinical preventive services in 2020, the last year for which numbers are available. That’s down from 8.5% in 2015.

Though most of us get some of the recommended services, nearly 95% of us are missing out on crucial opportunities to improve our health.

Meanwhile, public demand is fueling the growth of Prenuvo and Ezra, the two main companies offering full-body MRIs. In February, Ezra announced that it had raised $21 million, with a plan “to be present” in 20 cities and 50 imaging centers by the end of this year. In October 2022, Prenuvo said that it had raised $70 million to fund expansion and technology enhancements.

Media coverage over the last year by major publications also reflects the public’s fascination with full-body scans.

If we could re-direct this enthusiasm to evidence-based — albeit less glamorous — methods to detect and prevent disease, we could avoid a lot of sickness and death.

Mammograms — low-dose X-rays of the breasts — for example, are recommended for average-risk women starting at age 40 to identify breast cancer before it spreads. According to the American Cancer Society, the five-year relative survival rate, which compares women with cancer to those in the overall population, is a remarkable 99% for early-stage breast cancer. But nearly a quarter of women ages 50-74 are not up-to-date with their mammograms. Numbers are similar for cervical cancer screening.

For colorectal cancer, one of the most common cancers in the U.S., just under 60% of adults ages 45 to 75 years had received appropriate screening in 2021.

The deficits aren’t limited to cancer. Less than half of people ages 2 and up get regular dental care. A quarter of pregnant people don’t receive early and adequate prenatal care.

A report released last year by the National Association of Community Health Centers estimated that over 100 million Americans don’t have reliable access to primary care, the usual source for most preventive care.

I’ve seen the consequences: a delayed breast cancer diagnosis in a middle-aged single mom, heart failure in an older man after years of unrecognized hypertension, uncontrolled diabetes in many others, raising the risk of damage to the heart, kidneys, nerves and eyes.

Risks of over-testing

With all the benefits of preventive screening, one might argue, why not embrace full-body MRIs?

No preventive test is perfect. False positives are inevitable, creating anxiety and prompting additional investigation. We find — and even treat — early cancers that never would have spread, high blood pressure that never would have caused heart problems or a stroke.

Medical specialty societies, organizations such as the American Cancer Society, and the U.S. Preventive Services Task Force — an independent group of experts — regularly review the latest studies and update recommendations to guide selection of screening tests that balance risks with saving lives.

But with unregulated full-body scans, the guardrails are gone.

The very comprehensiveness of these tests is problematic. According to Dr. Richard Bruno, regent-at-large with the American College of Preventive Medicine, full body screenings in those without symptoms may lead to “incidentalomas” — benign findings in otherwise healthy people. Left undiscovered, many of these findings would never go on to cause problems, but “may warrant further testing and unnecessary procedures such as biopsies that can be costly and harmful,” Bruno said.

In fact, no major medical organization recommends full body scans in healthy individuals.

Low uptake of preventive services

The U.S. needs to shift its lopsided and short-sighted health care spending to focus more on disease prevention. According to Rear Admiral Paul Reed of the U.S. Public Health Service, we spend about 17% of our gross domestic product on health care. Almost all of it goes to “after-the-fact disease management.”

“We have an ever-worsening burden of chronic disease in this country that is coming with an extraordinary cost,” Reed said.

The U.S. spent $4.5 trillion on health care in 2022 — far more than any other nation. Yet only about 3% was directed toward disease prevention.

COVID was a major blow to preventive care efforts, leading to a decline in screenings and vaccines that has been slow to rebound.

A large study led by researchers from the American Cancer Society, for example, showed that the number of women who reported having cervical cancer screening decreased by 4.4 million in 2021 compared with 2019. Breast cancer screenings were down by 1.1 million.

Cost concerns, fear of “finding something,” and geographic and time constraints also contribute to low rates of preventive services. Being uninsured or not having transportation or a primary care provider limit access. Vaccine hesitancy and refusal are at higher rates than before the pandemic.

Lack of awareness is an additional barrier. In my practice, I regularly see patients who don’t know that they are due for colon cancer screening or hepatitis B vaccination.

Clinicians, too, may be confused about the guidelines, which change periodically. Breast cancer screening has created enormous controversy over the years, with reputable organizations disagreeing about when to initiate and how often to repeat mammograms. Pneumococcal vaccine recommendations are so complicated that I routinely have to consult the Centers for Disease Control and Prevention’s website.

Better communication and outreach can save lives

The solutions have to start with better communication between doctors and health care systems. Electronic records have the potential to notify busy clinicians when preventive interventions are overdue, but not all systems are equally effective.

Overall, we need a shift in focus from disease treatment to upstream avoidance, including well-funded educational campaigns to highlight the importance of prevention. Targeted outreach to communities known to have low rates of screening or challenges accessing services can improve rates of life-saving tests.

Reed contends that lessons from the pandemic may provide an opportunity to improve acceptance of preventive care. “I believe we — the public health and medical community — ought to leverage the heightened awareness of personal health, right now, and more deliberately engage the public on the importance of [clinical preventive services],” he said.

Full-body scans offer a tempting but unsubstantiated path to good health. If costs and rates of false positives can be reduced, the scans someday may find a place on a list of preventive care recommendations.

For now, however, tried-and-true strategies, from cancer screenings to vaccines, are the most effective way to safeguard our long-term well-being.

“The old adage that an ounce of prevention is worth a pound of cure,” Reed said, “is probably grossly underestimated.”

This story comes the nonprofit news outlet Public Health Watch.

Lisa Doggett is a family and lifestyle medicine physician at UT Health Austin’s Multiple Sclerosis and Neuroimmunology Center and senior medical director of Sagility. She is the author of a new memoir, Up the Down Escalator: Medicine, Motherhood, and Multiple Sclerosis.

The views expressed in her columns do not necessarily reflect the official policies or positions of Public Health Watch, UT Health, or Sagility. Doggett can be reached through her website.