Executive Health FAQs
- I have heard of a 'full-body Cat Scan' that can pick up tumors, coronary artery calcifications and even aneurysms. Why doesn't Virginia Mason offer this test?
- I want to be screened for ovarian cancer. Are there any tests that Virginia Mason can provide that can detect early ovarian cancer?
- Why doesn't Virginia Mason offer chest x-rays as screening tests?
- I have heard that CT scans can be used to detect coronary artery disease. Can I have this test done at Virginia Mason?
A: Virginia Mason has a long history of providing both cutting-edge medical care and of holding ourselves to strict scientific standards on quality and efficacy. On the issue of full-body CT scans, our Radiologists and Internal Medicine specialists feel that these tests carry more potential for harm than benefit to patients. The vast majority of abnormalities picked up by a full-body CT turn out to be benign cysts or nodules but require surgery to or other invasive studies to diagnose with certainty. Most early cancers of the internal organs will also be missed by a CT scan done without intravenous contrast. There are more targeted imaging procedures that Virginia Mason physicians do endorse (i.e. CT pulmogram to screen for lung cancer, Coronary artery calcium scanning). Virginia Mason physicians will continue to monitor scientific studies on these tests but, for now, we agree with the American Cancer Society and the American College of Radiology views: Robert Smith, PhD, director of the American Cancer Society's screening program:
"[The full-body Cat Scan is] a waste of money and a bad idea ... As cutting edge as the technique seems, we do not know whether this test is even as good as other conventional screening tests that have been around for a long time,"
The American College of Radiology's position statement on total body CT screening:
"The American College of Radiology (ACR), at this time, does not believe there is sufficient scientific evidence to justify recommending total body computed tomographic (CT) screening for patients with no symptoms or a family history suggesting disease. To date there is no evidence that total body CT screening is cost-effective or is effective in prolonging life. In addition, the ACR is concerned that this procedure will lead to the discovery of numerous findings that will not ultimately affect patients' health, but will result in increased patient anxiety, unnecessary follow-up examinations and treatments and wasted expense. ACR will continue to monitor scientific studies concerning this procedure." — September 2000
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Q: I want to be screened for ovarian cancer. Are there any tests that Virginia Mason can provide that can detect early ovarian cancer?
A: Two tests have been carefully studied as screening tests for ovarian cancer - pelvic ultrasound and the blood test, CA125. At this time, neither test is accurate enough to be used to screen low-risk individuals and both carry more risk of harm than benefit. The ultrasound test is far from perfect at distinguishing cancer from benign disease and will lead to unnecessary surgery as a result. The CA125, while a fairly accurate marker of advanced ovarian cancer, is often normal in ovarian cancer when it is at a curable stage. Also, so many conditions besides ovarian cancer elevate the CA125 that the majority of 'positive' tests are false positives; this also can lead to unnecessary anxiety and risk from invasive follow-up testing. While most physicians recommend annual pelvic examinations for women, it is difficult if not impossible to detect early ovarian cancer by physical examination. For women with family history of ovarian cancer, many physicians do recommend screening and we suggest discussing this either with our genetic counselor or with the Executive Examination physician. For women with average risk for ovarian cancer, we feel that currently there is no test we can offer that is accurate and safe. There is some promising research on serial CA125 testing and we will continue to study this issue carefully. (Reference, Screening for ovarian cancer, Karen J Carlson, MD, UpToDate Version 9.2, April 2001).
A: Quite simply, chest x-rays are useless as screening tests in people - even smokers - without symptoms. Numerous studies have demonstrated this lack of benefit; there are, as well, potential risks both from radiation exposure and from invasive tests to follow up on false positive findings. There is no professional medical association that recommends regular chest x-rays on asymptomatic people.
A: Atherosclerosis (hardening of the arteries) is a complex combination of cholesterol, muscle cells and calcium deposits. Xrays can detect calcium and there are many studies underway examining the use of a special type of x-ray - the CT scan - to quantify coronary artery calcification Although this test is still under study and is prone to false positive and negatives, we feel that it is superior to other non-invasive screening tests for coronary disease (like stress tests). Coronary artery calcium scanning is available as part of the Executive Examination program at Virginia Mason and we recommend that it be ordered after a discussion of the pros and cons with an Executive Examination physician.
Virginia Mason Executive Health Program
Executive Health Program
1100 Ninth Avenue
Mail Stop: X11-EE
Seattle, WA 98111