Direct-to-consumer health screening

Which health screens do more harm than good?
 
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02.Scans

Health screening test

Scans covered here include

Screen For Life

A private company called Screen For Life sends letters to people in their fifties, offering cardiovascular ultrasound screening. With its tagline, “prevention for peace of mind”, the company argues that by having the ultrasound they can detect potential risk factors for stroke, heart attack and aneurysm, allowing you to take preventative action – or else give you the all-clear and peace of mind.

The letter itself is quite alarming, pointing out that stroke “is the second leading cause of death in Australia”, and that even if it doesn’t kill you, it “can leave you unable to walk, talk, or take care of your most basic bodily needs”. A package of four screenings costs $199 (not covered by Medicare or private health insurance), but “the reassurance of a health screening can be priceless”.

The screenings have undoubtedly helped some people who were able to take action to prevent a serious health event. However, critics point out that while there’s no harm (apart from the cost), it can provide false reassurance or cause unnecessary alarm.

And there’s little evidence such screening reduces the risk of stroke. For example, one test is a scan of the carotid arteries in the neck, where plaque deposits can stiffen and clog arteries, leading to stroke. But health experts point out that many people have evidence of hardening arteries without an increased risk of stroke. It could also provide false reassurance, leading people to think they have no risk factors and continue their unhealthy lifestyle habits.

Screen For Life says the service is conducted by appropriate health professionals, although it has been criticised for taking place in settings such as church halls and RSL clubs that aren’t under control of a registered health organisation. The National Stroke Foundation stresses it has no links with Screen for Life, saying it doesn’t recommend unnecessary tests and that if you have concerns to see your GP.

DEXA scan

The newish kid on the screening block is DEXA (dual energy X-ray absorptiometry) body scans. A DEXA scanner produces two X-ray beams, one with high and one with low energy. They pass through bone to different degrees, allowing bone density can be measured.

While used for a long time for measuring bone density and risk of osteoporosis, clinics now offer it for measuring body composition (muscle and body fat) as well. In particular, they’re targeting bodybuilders and people trying to improve their health and fitness by measuring actual changes in body composition, which can help people determine whether their particular exercise program is having the desired effect. Some offer the services of an exercise physiologist as well.

You don’t need a doctor’s referral for a DEXA body composition scan, and it’s not covered by Medicare, although your private health insurer may cover a consultation with an exercise physiologist.

Full-body CT scans

Popular in the early 2000s, full-body CT scans were promoted to people without any symptoms of illness or disease risk factors. Thanks to increased regulation they’re less common now, but are still around and also available overseas to medical tourists. Depending on the country, providers may be less well-regulated than their Australian counterparts, so Australian government and health authorities continue to warn against them.

Said to be able to detect early signs of diseases such as cancer and cardiovascular disease, full-body CT scan advocates claim the diseases can be treated more effectively if discovered early. And studies have found that rate of cancers among apparently healthy people who request full-body scans is around two to five per cent – so that small percentage of people is theoretically better off having had the scan.

However:
  • For someone lacking signs or symptoms of disease, it is unlikely to detect a serious disease early enough to treat it and alter the outcome significantly.
  • CT scans can return suspicious findings that turn out to be harmless – for example, scar tissue from an old infection, calcifications, cysts and nodules. Doctors have even coined the term “incidentalomas” for benign lesions found incidentally through scanning when there are no symptoms or other suspicions. Meanwhile, the patient undergoes more invasive and expensive testing, suffering the fear and anxiety that accompanies the threat of a potentially serious problem.
  • Exposure to CT radiation during a full-body scan is about 500 times that of a chest X-ray. This is associated with a small increase in risk of cancer.
  • Full-body scans may also miss hidden cancers, wrongly leading the patient to think everything is fine and that they don’t need to see their doctor or have other specific screening tests (mammograms, bowel and prostate cancer screening, for example).
  • They’re expensive, and aren’t covered by Medicare or private health insurance.

CT scans are a useful diagnostic tool for cancers, and when used in targeted areas, the radiation risks are outweighed by the potential benefits of treatment. But for screening the “worried well”, the risks outweigh the benefits.

The tests you should have

These mainstream screening tests are recommended for the relevant people:

  • Breast cancer: mammogram. Recommended every two years for women aged 50-74.
  • Bowel cancer: faecal occult blood test. Provided by the government for people aged 50, 55, 60 and 65.
  • Osteoporosis: bone mineral density (BMD) scan. Recommended for women at the start of menopause, for women after menopause and for men according to medical advice (based on risk).
  • Cervical cancer: Pap smear. Recommended every two years for women over 18 who’ve ever had sex.

Other screening tests:
  • Blood pressure test for hypertension
  • Blood lipid screening for cholesterol and triglycerides
  • Blood glucose test for type 2 diabetes
  • Vision and eye health, including cataracts (a clouding of the lens), macular degeneration (degeneration of the macular, the very central area of the retina) and glaucoma (a group of diseases where the optic nerve is gradually destroyed).

A test you might have: PSA and rectal examination

Some recommend once a year for men aged 50-70 to detect prostate cancer. But this is controversial, and health professionals recommend you speak to your doctor about the risks and benefits of screening.

Our article on healthy ageing provides more information on the PSA test and the other screens listed above.

 

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