Protecting the 'worried well'

19 April 2010

By Joanne Curran, associate editor, MDDUS

THE adverts are particularly eye-catching. Prevent heart attacks! Reduce the risk of undetected diseases! Take charge of your future!

These are just some of the taglines found on various websites offering advanced health MOTs and body scans. Potential clients are invited to seek peace of mind about their health by undergoing "preventative testing" at any number of private clinics and centres across the country. This can involve undergoing full body CT scans to assess everything from bone density to heart, lung and colon health with prices ranging from as little as £45 to well over £1000.

There has been scepticism amongst some medical professionals for several years about just how necessary and effective some of the procedures are. But for the first time, the Department of Health has moved to make its position on the issue official. It has announced a crackdown on companies offering computerised tomography (CT) scans for the 'worried well'. The DoH accepted all nine recommendations made by the Committee on Medical Aspects of Radiation in the Environment (COMARE).

But they stopped short of an outright ban, as the DoH said: "It will not ban or prohibit any scan but will mean they are clearly brought within the regulatory regime and distinguished from diagnostic scans."

Cancer risk

The move has come amid concerns that these scans are exposing individuals to excessive radiation which may increase their cancer risk. Each one can be up to 400 times more powerful than a chest X-ray. In the USA health scans are becoming increasingly popular and the committee estimates that some 15million people have chosen to have full body scans in the past three years. This equates to the cumulative radiation dose in the survivors of the atomic bombings at Hiroshima and Nagasaki.

Companies offering these scans in the UK will now have to conform to the Ionising Radiation (Medical Exposure) Regulations 2000. The move – which comes almost three years after COMARE first published its recommendations – means whole body scans for people without symptoms should cease as well as specific scanning of the lung in asymptomatic individuals. Scans for spinal conditions, osteoporosis and body fat assessments should also stop as more appropriate lower risk methods are available.

Other changes include restricting screening for coronary artery calcification to people of intermediate risk or those referred by a cardiac specialist. Scans should not be carried out more than once every three years. COMARE also said screening for colorectal cancer outside NHS screening programmes should only be carried out on the over-50s unless referred by a specialist. Scans must be in line with NHS screening programmes and only be carried out once every two or three years.

Regulatory control

All of this means self-referred CT scans will be defined as an Individual Health Assessment and as such will be brought under regulatory control and distinguished from diagnostic scans. The report said: "There is little evidence that demonstrates for whole body CT scanning, the benefit outweighs the detriment" and "if 100,000 people undergo a CT scan every five years from age 40 to 70 ...then the estimated impact is approximately 240 excess fatalities."

The DoH will now seek help from the Royal College of Radiologists and the Royal College of Physicians in preparing guidance for practitioners.

Public Health minister Gillian Merron said: "Any scan a patient undergoes should balance the clinical benefits against the risks of the radiation involved."

The changes have also been welcomed by Dr Tony Nicholson, dean of the Royal College of Radiologists. He said: "This regulation will make the rules on CT scans more understandable. It's just not possible to justify using ionising radiation if there's no proven benefit."

Some in the medical profession may be wondering what has taken the government so long to act on the increasing use of full body scans. An investigation by Pulse magazine in June 2009 reported on how GPs were increasingly having to deal with concerned patients approaching them with results from private testing and looking for follow-up treatment on the NHS.

Dr Andrew Green, a GP in east Yorkshire and member of the BMA’s GP committee, told Pulse: "The first rule of medicine is first do no harm, and I’m uncomfortable with the notion these tests do no harm. They do, and I don’t just mean the psychological harm and anxiety caused by being told there’s something wrong with you."

But supporters of body scans have accused critics of taking a "paternalistic approach" to the public. In a BBC report from 2007 into private screening firms, John Giles, an NHS consultant radiologist and clinical director of the company Lifescan, said: "Screening is a personal decision and people are fed up with this paternalistic approach which tells them they can't make choices for themselves."

It can only be hoped that the new guidance from the DoH will offer greater protection for the 'worried well' who are tempted to pay up for a private health MOT.