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WHAT LIES BENEATH

HEALTH: PEOPLE ARE UNDERGOING AN ELECTIVE FULL-BODY CT SCAN TO DETERMINE THEIR HEALTH, BUT EXPERTS ARE DIVIDED ON THE TEST'S VALUE

Stories by Lisa Liddane
The Orange County Register

They resemble black and white topographical maps taken by an aerial photographer.

The images on the computer screen show the insides of your body, taken 15 minutes ago in a full-body computed tomography scan.

Interpreted accurately, a CT scan can show heart disease, aneurysms, vascular disease, lung cancer, benign tumors, emphysema, ovarian disease, kidney stones, gallstones, prostate disease, abnormalities in the back including disc disease, bone abnormalities, osteoporosis, endocrine disease, and abnormalities in the ovary, uterus, adrenal gland, spleen and gallbladder.

As he moves the mouse around, Newport Beach radiologist Dr. Harvey Eisenberg takes you on a fantastic voyage into the nooks and crannies of your heart, lungs, arteries, organs and bones. On this sort of virtual reality tour of your insides, he is like a deep-sea diver trying to find hidden mines: plaques that may rupture arteries and trigger a heart attack, abnormal growths that could be early signs of cancer.

Fascinating? No doubt. Necessary? That's debatable. The number of people undergoing this screening has increased exponentially, as word continues to spread from patients to their friends and families, from reports on TV and other media and advertisements, some radiologists say. Eisenberg's facility, HealthView, is solidly booked through December 2001. HealthView conducts 36 such scans a day.

For these people, uncovering the unknown is better than being caught unaware later by a disease that might have been treated earlier. Some doctors say seeing the test results is the most powerful motivator for changing to a healthier lifestyle.

But others say there isn't enough evidence to show that the test is solid, accurate and cost-effective for managing one's health. While there are no definitive answers yet, people considering the test should weigh what research has shown about the strengths, weaknesses, potential benefits and drawbacks to make an informed decision.

SOME PATIENTS
WANT TO KNOW

"I'm a real believer in prevention, whether it's preventive law or preventive medicine," said Mari Frank, 52, a Laguna Niguel attorney who underwent the screening. "It's a good idea at my age to find out what's going on inside me. I don't think it's wise to wait until you're feeling sick to know what's going on with you."

Frank was particularly concerned about what the test would reveal about the chronic pain that she felt in her lower back. "What showed up was degenerative disease, which is very common ... it was a relief to know that it wasn't a tumor. You could see that there was less space between bones in some places. My right side was slightly different from my left side."

As for the rest of her, the test showed nothing of concern in her heart, lungs and organs. "I was relieved to know my heart looked good, my lungs were very good. From what the doctor could see, everything looked quite good."

Rick Wells, director of the Los Angeles Police Protective League, found the screening radically changed his life so much that he recommended it to the Los Angeles Police Department, which in turn, approved it for officers.

The test showed a lot of plaque buildup in his coronary arteries, making him a candidate for a heart attack. Wells said he altered his lifestyle in pursuit of better health. He said he takes medication to control the arterial plaque, eats a healthy diet, exercises regularly and makes a conscious effort to manage work stress.

"I want to live to see my son, who is now 7, graduate from college," Wells said.

LET'S WAIT AND SEE,
SOME DOCTORS SAY

Some doctors, however, say the use of total body CT scans may be premature.

The American College of Radiology, an association of radiologists, recently stated that there is not enough evidence to justify recommending the screening for people with no symptoms or a family history of disease. It has not been found to be cost-effective, the ACR stated.

The ACR said it will continue to monitor studies regarding the procedure.

Although studies on the use of CT scans for specific parts of the body such as the lungs are promising, even favorable, more studies are needed for other parts, such as the abdomen, said Dr. Anton Hasso, chief of the radiology department at the University of California, Irvine.

In addition, Hasso said there already are diagnostic tools such as the DEXA scan for osteoporosis, a colonoscopy for colon cancer, and coronary angiography for heart disease.

And he questions whether the tests play on seemingly healthy people's paranoia about their health. Here's one possible scenario: A patient receives CT scan results that are worrisome, but not definitive, such as cysts. He or she undergoes other tests. The cysts turn out to be benign.

In the meantime, the patient has spent time becoming worried and anxious about his or her life.

Hasso also points out that the amount of radiation exposure should be considered. Though the radiation won't cause damage immediately, adverse genetic effects may show up in your offspring, he said. "It's the risk for the genes of future generations," he said.

It's too early to tell whether this test is advisable, even if the prospects are exciting, said Dr. Norman Rosen, Orange County spokesman for the American Academy of Family Physicians. It's something that needs to be discussed on an individual basis, he said.

"The use of the screening should be balanced with the ability to intervene in a patient's health," he said. Otherwise, the test addresses only questions of curiosity.

Rosen said that occasionally a routine X-ray will detect advanced lung cancer at a stage when it's too late to treat.

Rosen also brought up the possibility of false negatives - when a test shows that all is normal - even if it isn't. "That peace of mind may be misplaced," Rosen said. "I am concerned that a person may have the test and be reassured that everything is OK, then fail to follow up with doctors for other surveillance or may not continue health maintenance."

EARLY DETECTION CAN
LEAD TO INTERVENTION

Some doctors say this is how medicine ought to be practiced. "It's proactive, not reactive," said Eisenberg, HealthView's CEO. This test is not a substitute for a physical exam, but a complementary diagnostic tool, he said.

"This is the future of medicine," said Dr. Eugene Levin, who has an internal-medicine and cardiology practice in Laguna Beach and is clinical professor at UCI. Levin, 73, had his first full-body CT scan seven years ago.

Levin recommends the test to those of his patients who can afford it and those whom he thinks need it. But he advises the patients not to conclude anything until they have discussed the results of the test with him.

Family practitioners tend to have much more experience in individualizing the results, he said. What the family physician does is examine the results, determine which information is worth being concerned about and which is unworthy of worry.

While it's true that there are other tests for specific areas of the body, one of the advantages of the full-body CT scan, especially if you include the colonography, is that it is noninvasive, not uncomfortable, said Dr. Steve Koch, radiologist at InsideTrac in Beverly Hills. Plus, you get the rough equivalent of several tests in one stop.

Some traditional tests and screenings for heart disease and cancerous tumors can be limited and flawed, Eisenberg said.

He points out that the technology used for his CT scans is safe and more precise than ever.

This enables him to find abnormalities earlier - before they become full-blown and less manageable.

As for the lack of research, Eisenberg says his 15 years of heart screening and several years of full-body screening give him all the data he needs.

"I have yet to come across a patient who did not have findings that need to be addressed," he said.

"One of the criticisms against what we do is that we're scaring people," Eisenberg said. "But our real job is to motivate people to take care of their health."

LOOK OUT, BEFORE LOOKING IN

Should you have an extensive CT scan done? Medical associations for physicians have not recommended this test as a screening tool. Here are factors to consider and discuss with your doctor before deciding:

Your age. In general, heart, lung and degenerative diseases are less common in younger people. Most facilities that offer the screening recommend the test for people 30 and older.
Your family history. A family history of heart disease, cancer or osteoporosis might make you a candidate for screening.
Your lifestyle: You might benefit from the test if you have high blood pressure, elevated cholesterol, diabetes, a high-stress life, smoked, consumed too much alcohol, are overweight, are sedentary.
Your willingness and readiness to deal with any adverse findings of the test.
Your doctor's willingness to accept the results of the screening.
Your health insurance. Most health insurance companies do not cover this screening. But will they consider the results of a test that you have paid for out of pocket, if the screening shows you may need further tests or treatment.