CT screening: a trade-off of risks, benefits, and costs

Abstract

Screening for disease with computed tomography (CT) is fast becoming an enterprise. Whole-body CT screening is heavily marketed in the US, and while marketing directed toward the European population is less aggressive, the interest is no less. Direct consumer advertisement reaches out to the “worried wealthy” individual, who is usually healthy! CT screening is advertised on billboards, in newspapers, on television, and through the Internet. Selective information, astute framing of the data, and subliminal messages lure the individual to undergo a scan. Health care consumers are increasingly well informed due to modern information technology and, as a result, are demanding high-technology health care. CT screening addresses the main killers of the Western world: coronary heart disease (CHD), lung cancer, and colorectal cancer. In addition, abdominal aortic aneurysms (AAAs) are easily detected with CT. Abdominal tumors, other than colorectal cancer, may also be detected with CT. Powerful anecdotes that favor screening abound. Employer, peer, and family pressure may also influence an individual to undergo CT screening in the absence of symptoms that would normally warrant investigation. But where is the evidence that screening with CT does more good than harm? This evidence is lacking. Currently, no large-scale randomized controlled trials (RCTs) of screening with CT are published in the literature. The cost-effectiveness analyses published thus far that evaluate screening with CT are generally based on sparse data and questionable assumptions. Published cohort studies provide some evidence of diagnostic and prognostic value, but that is not enough to support the large-scale use of CT screening of ostensibly healthy individuals. The trade-offs need to be clarified. As yet, it is not clear that true-positive findings lead to gains in life expectancy and quality of life. Furthermore, for some diseases, the large proportion of false-positive results and the risks, anxiety, and costs associated with the further diagnostic workup required argue strongly against screening. Recently, powerful anecdotes have illustrated