Body scans not proven to increase longevity
May 7, 2024
There is a growing “longevity” movement, and many have proposed that increased screening can find disease early when we can better intervene. Some have suggested that full body scans could both save lives and decrease health care costs. However, such screening can unearth abnormalities that don’t matter, and encourage a “cascade” of tests where those in good health take serious health risks to assess an issue unlikely to pose a threat.
Whole body CT scans, which use a computer and radiation to construct a three-dimensional image of the body, have been used for such screening for a few decades, although they have fallen out of favor in recent years. One problem is that these tests had high false positive rates, so that many people were asked to have follow-up ultrasounds, CT scans or other tests based on initial findings. Another problem is that CT scans use radiation, and each scan exposes a patient to about three times the annual amount of background radiation. Whole body CT scans can be useful for patients with symptoms or known disease but are not recommended for healthy people with no symptoms. They are not considered “medically necessary” and are therefore not generally covered by employer-sponsored health insurance plans. Here is a link to the Food and Drug Administration (FDA) guidance on full body CT scans.
Whole body MRI (magnetic resonance imaging) scans have been used more recently to screen healthy people. These involve no radiation exposure but about a third (32%) of these scans find some sort of abnormality. Positivity rates are higher if the heart or the colon are included. One study of volunteers in Germany showed that those who had screening MRIs had 18% higher total medical costs over two years of observation. Moreover, there is no solid evidence that these scans increase the chance of living longer. These are not considered medically necessary and are also generally not covered by an employer-sponsored health plan.
The New York Times weighed in last weekend with a report by a business journalist who flew to Stockholm, Sweden to get a whole body scan from a company founded by Daniel Ek, the founder of Spotify. These scans were neither a CT nor an MRI, but rather a combination of photographs and pressure scans of various parts of the body, for instance, checking blood pressure, blood vessel stiffness, and even pressure inside the eye. The scans are targeted to be lower cost than CT or MRI scanning and used in conjunction with screening blood tests. There is no published data to demonstrate that this type of scanning will find earlier more treatable disease or save lives.
The founders asserted that their product could lower the cost of health care by emphasizing early diagnosis, but in fact, there is no evidence-based early cancer diagnosis available now that lowers medical costs even over a long-time horizon. Health care policy experts generally hope that a “cost effective” intervention costs less than $100,000 for a “quality adjusted life year.” Advances in health care can bring us longer or better lives, but they generally don’t come with a rebate!
Implications for employers:
- Be aware that new screening tests are highly unlikely to lower health care costs because many individuals must be screened and undergo follow up tests for each person who is diagnosed with earlier disease.
- Not every case of earlier diagnosis leads to longer or better lives. Finding cancer earlier can lead to an improved five-year survival rate even if earlier diagnosis does not delay a person’s death.
- Most carriers have well-developed technology assessment programs, and employers can look to their carriers to help them to determine whether they should cover such procedures.
- Executive physicals do not require medical necessity, and even those exams rarely include full body scans.
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Illustration by Dall-E
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