Weighing value, risk of full-body scans

Ethics Forum. March 5, 2007.

Is it ethical for a doctor to run a facility offering elective imaging?

There are more than 108 commercial imaging facilities in the U.S., offering heart, lung, brain and other scans to asymptomatic people. Under what circumstances is it ethical for a doctor to own and operate a self-referral, full-body imaging facility?

Reply

Recent events have placed the practice of self-referred, elective, full-body screening in the spotlight. Study results published in the New England Journal of Medicine in the last year suggest that CT screening may increase survival rates among asymptomatic patients with early-stage lung cancer. Direct-to-consumer advertising continues to spark demand among a health-conscious patient population. And, although the practice is not currently supported by organized medicine, its growing popularity and public interest are outpacing the availability of evidence about its efficacy.

Proponents argue that its potential risks are outweighed by the benefits of early detection for many common, serious diseases and the potential increase in survival rates through early intervention. Meanwhile, the ethical implications of widespread screening that may affect the health of tens of thousands of individuals have garnered little attention.

Typical full-body CT exams evaluate the chest, abdomen and pelvis for cancer, cardiovascular disease and other presymptomatic disease findings. Centers have begun offering specialized services, including CT lung screening for patients with a history of smoking, coronary calcium scoring to assess heart disease, and CT colonoscopy to detect or prevent early colon cancer.