Use of CT Scans for Early Detection Gains

By SHARAHN D. BOYKIN, Capital News Service

ANNAPOLIS - Lorraine Burdette was not worried when the radiologist called her to his office to discuss results of her full body computed tomography scan, also known as CT scan. She thought she would be told her everything was fine - just as her husband had been after his scan a few days before.

"I am a person that would get my once a year pap smear, and I would get my mammogram ... I did all the general things that all of us do," said Burdette, who stayed in shape by taking yoga classes and walking for 25 to 45 minutes five times a week.

But instead of the clean bill of health she was expecting, the radiologist told her he saw something "sort of dark" in her kidney. Early the next day, Burdette received a call from the CT screening center, YourScan, telling her she need to have additional test right away.

Within days, Burdette got the news: She had cancer.

Doctors told her three-fourths of her right kidney was cancerous, and that it would have to be removed. It was a slow-growing cancer, they said, and it would have probably been a year before she would have begun to experience symptoms.

Burdette was one of a growing number of people who opted to pay out of their own pocket for various kinds of CT scans in hopes of detecting diseases they have no reason to believe they have. Health insurance companies usually don't pay for the screenings.

But despite their growing popularity, use of the scans on apparently healthy people is still controversial.

The American College of Radiology warns against having them performed unnecessarily. "If there is no medical reason for having a test done that involves radiation we are not in favor of it," said Shawn Farley, a spokesman for the American College of Radiology.

The CT screenings at YourScan, in the Weems Creek Medical Center in Annapolis, range from $195 for a heart scan to $950 for a full body scan and virtual colonoscopy. Individuals may be eligible for a reduced rate by participating in their Healthy Lung Scan clinical trial.

"I've seen too many patients walk in off the street feeling fine and found they had a significant disease," said Dr. James Reinig, a YourScan radiologist who himself had a heart scan and a virtual colonoscopy when he turned 50.

The CT screenings are perhaps finding their greatest acceptance among medical professionals as a way of detecting lung cancer earlier than a normal chest X-ray would.

St. Agnes Hospital in Baltimore offers lungs scans for as little as $75 as part of the International Early Lung Cancer Action Program clinical trial. But, participants must be 50 or older and must be a smoker or have been exposed to second hand smoke.

"I believe this is the biggest breakthrough in lung cancer in the past 15 years," said John Welby, a St. Agnes spokesman. "This is a giant leap forward for lung cancer." `

A study in the New England Journal of Medicine found that screening was effective in detecting lung cancer in the early stages when it is treatable. But some researchers question whether the screening is effective on large populations and worry about the impacts the results may have on patients.

"CT is very good at detecting pathology in the lung," said Dr. Elliot Fishman, a professor and radiologist at Johns Hopkins University, "but simply detecting is not enough."

Johns Hopkins is one of several test sites for the National Lung Screening Trial which is comparing the risk and benefits of spiral CTs and chest X-rays in detecting lung cancer.

One of the problems some experts and health care organizations see with the scans is that they can lead to an increase health care costs and patient anxiety when apparent irregularities are found and more tests are ordered up.

"There is no doubt that CT is sensitive enough for picking up lung cancer," Fishman said. "But the question is, is it the right thing to do?"

With lung screenings, if a nodule is found, sometimes patients will have to wait several months for a follow up visit to see if the nodule grows. This waiting period can be an agonizing source of anxiety Fishman said.

The National Cancer Institute reports that studies show that in CT scans of smokers and former smokers, 25 percent to 60 percent will show abnormalities. The institute reports that these abnormalities can range from smoking scars to inflamed areas and sometimes look like lung cancer on a scan.

Johns Hopkins will only perform the scans if the patient has a referral from a doctor.

"We want to make sure if we see something you're managed correctly," Fishman said.

Whether for the lungs or the full body, proponents say the screenings are not geared toward young healthy individuals with no family history of disease.

"Somebody that is younger is probably not going to have a whole lot of findings," said Julie Miller, a spokeswoman for YourScan." We didn't want to have unnecessary exposure to radiation." Individuals must be at least 30 for heart and lungs scans and 40 or older for full body scan and virtual colonoscopy at YourScan.

For patients like Burdette, though, the value of having a scan is not debatable.

Since having her kidney removed three years ago, she has been cancer free and has a check up each year.

"Having the scan saved my life," Burdette said. "I thank God everyday I had the scan."

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