Scanning for Truth
Posted on January 7, 2011 in Underwriting - Risk Differentiation
What total body scans can – and cannot – do for you
Total body CT scans are being heavily touted in the media as the newest way to quickly as well as painlessly screen for a wide variety of potential health problems. Just about anyone driving home from work will hear at least one radio commercial on scanning, whether it be just for the heart or the entire body. The concept of catching developing abnormalities and/or potentially life threatening conditions before the body is caused irreparable harm appeals to the majority of individuals. But who should have these scans and should life insurance include one in all of its requirements?
Body scans are not inexpensive. While the procedure can typically be completed in less than an hour, the average cost is under $1,000. Generally, scans are not covered by health insurance, resulting in an out of pocket cost for the individual getting the scan. Additional costs may accrue due to questionable findings, which oftentimes leads to confirmatory or diagnostic testing.
Along with monetary concerns is the potential for various health consequences as a direct result of the scan. Body scans expose the individual to significant radiation and while each machine is different with each operator spending different amounts of time performing the test, the radiation received from one body scan is equivalent to around 150 chest X-Rays. While there is no current standard on how many pictures should be taken, as well as the thickness of the film, the radiation absorbed from even a single procedure is clearly significant.
Scans are useful in diagnosing very significant diseases early so it can be treated early. For example, detecting cardiac calcification in an at-risk person allows the individual to start medication and make the appropriate lifestyle changes before significant damage or build-up occurs. However, detection can also occur through using traditional, less invasive and expensive testing such as exercise or echo testing. These methods tend to be easier to follow-up with and are equally useful. On the other hand, methods like the CT scan cannot give as precise a location of the diseased portion of the artery as other tried-and-true imaging tests, such as cardiac catheterization, nor can it detect a soft plaque which is identified in current research as one of the major causes of heart attacks. However, a total body scan may demonstrate a finding that is questionable without further testing. Additional tests, some of which may carry a greater risk, may be necessary to clarify the scan’s results.
Scans can also detect even minute findings that have no clinical significance. As mentioned previously, if anything abnormal is found, it sparks a round of confirmatory testing that includes X-Rays, scans, blood tests, and sometimes biopsies. In cases where doctors are convinced that there is little chance of pathological significance, a failure to confirm or deny any perceived abnormality can open the doctor up to possible legal consequences. As such, it is hard to determine whether follow-up testing is the most practical alternative, and most people will end up going through it regardless of the risk.
Another problem arises when a full body scan may not turn up a noticeable abnormality. Possible issues arise when an individual experiences symptoms and does not take the symptoms seriously through having them investigated because the “normal” body scan showed no abnormalities.
That being said, total body scans are advantageous in certain situations. For example, high-risk individuals have the proposed benefit of having a total body scan for early detection and treatment. In general, the earlier a condition is diagnosed and treated, the greater the chance for long-term survival. In patients already diagnosed with various diseases, scans can help evaluate disease progression, and help doctors determine the severity as well as which medications should be prescribed. Scan results can also help physicians assess whether or not treatments are working effectively.
It is important to remember that total body scans provide a “snapshot” in time of the anatomy of the individual’s body. The scan does not detect all diseases, nor does it provide a guarantee that diseases will not develop in the future.
The possibility of people being able to go to a doctor’s office, be run through a machine and know what their total body health and status is on a periodic basis may one day come true. At the moment, full body scanning does not meet this requirement and neither the American College of Radiology nor the FDA sanction full body scanning unless there is a clear medical benefit that outweighs any associated risk. As such, insurance underwriting will have to consider such scans in the same context as it does every bit of medical information it receives- as just another piece of the puzzle in trying to assess the health of an individual applicant.
Written By:
Robert Denny
Director of Underwriting