6 ms·

What's the problem with full body MRI scans for healthy people? They don't cause any harm, just cost money.

by s3nnyy 9y ago

CaptainZapp 9y ago
Apart from the fact that it costs a lot of money. What do you want to achieve with a full body MRI scan?
- s3nnyy 9y ago
  A friend of mine who wasn't even 30 years old had a serious brain tumour where they said "ouh, if we'd had done a MRI scan some years ago, it would have been much easier to fix." So that is why it might be a okay'ish idea to do a MRI scan of the brain every 5 years or so? Depending where you live they are actually cheap and can be paid out of pocket.
  - CaptainZapp 9y ago
    Fine and fair enough. But that scan would be limited to the head and not cover the entire body. I'm also not convinced that MRIs are a great, general purpose diagnostic tool, if it's not used to diagnose concrete issues. The experience of your friend, who I hope recovered from the tumor not withstanding.
  - FireBeyond 9y ago
    With those caveats in place, absolutely. In the US, studies have been shown that physicians who own shares in CT (not so much any more, as it becomes almost 'commodity') and MRI (which is a lot, manufacturers approach physicians to form imaging cooperatives) are ordering imaging up at more than 2 standard deviations from expectations. As noted, MRIs in themselves aren't harmful. But with prices in the four digits in the US... you can easily pay off your $1.5M MRI machine in 18 months and be printing money with your over-imaging.
jartelt 9y ago
MRIs should be safe. It's the unnecessary CT scans you want to avoid. Those blast you with x-rays and increase your risk of cancer by a non-negligible amount.
- astura 9y ago
  MRIs on healthy, asymptomatic individuals are not "safe," they cause harm due to overdiagnosis and overtreatment. I know TFA was a long read but it explains it, CTRL-F "turtle" to get to the part about tumors specifically. Here's a similar explanation: https://sciencebasedmedicine.org/a-skeptical-look-at-screening-tests/ https://sciencebasedmedicine.org/a-skeptical-look-at-screeni...
  - jartelt 9y ago
    Agreed - I was simply stating that the act of getting an MRI does not cause harm, whereas some other tests (CT scans, X-rays, etc.) actually cause harm during the course of the test. I certainly would not recommend healthy people to get MRIs. But if something is really messed up in your body, an MRI is one of the safer imaging techniques (albeit expensive and not always the best for the job).
- Omnus 9y ago
  Not really. The absolute worst estimates for CT scans increasing your risk of fatal cancer is around 1 in every 2,000 scans. That statistic almost certainly isn't true, since we'd see skyrocketing cancer rates since the development of CT scans, which we haven't. But even assuming it was true, that's pretty close to a "negligible" risk. 1 in 5 people will die from cancer. That's 400 out of 2000. Getting a CT scan makes your risk 401 out of 2000 in the worst possible scenario. If anything, that's an argument for more CT scans (as long as they're necessary or preventative), especially if you're at risk for certain types of cancer and could detect it early with preventative scans. MRIs would be better in that case, but you aren't going to die from a CT.
astura 9y ago
They cause harm due to overdiagnosis and over treatment. https://sciencebasedmedicine.org/a-skeptical-look-at-screening-tests/ https://sciencebasedmedicine.org/a-skeptical-look-at-screeni...
- paulsutter 9y ago
  Scans don’t cause overdiagnosis. Eager checklist-driven doctors cause overdiagnosis. You will see incidentalomas, how you use that information is not preordained.
  - astura 9y ago
    Scans directly cause overdiagnosis. It's very non-intuitive but scans and tests have the potential to cause more harm than good. From TFA: >Overtesting has also created a new, unanticipated problem: overdiagnosis. This isn’t misdiagnosis—the erroneous diagnosis of a disease. This is the correct diagnosis of a disease that is never going to bother you in your lifetime. We’ve long assumed that if we screen a healthy population for diseases like cancer or coronary-artery disease, and catch those diseases early, we’ll be able to treat them before they get dangerously advanced, and save lives in large numbers. But it hasn’t turned out that way. For instance, cancer screening with mammography, ultrasound, and blood testing has dramatically increased the detection of breast, thyroid, and prostate cancer during the past quarter century. We’re treating hundreds of thousands more people each year for these diseases than we ever have. Yet only a tiny reduction in death, if any, has resulted. >H. Gilbert Welch, a Dartmouth Medical School professor, is an expert on overdiagnosis, and in his excellent new book, “Less Medicine, More Health,” he explains the phenomenon this way: we’ve assumed, he says, that cancers are all like rabbits that you want to catch before they escape the barnyard pen. But some are more like birds—the most aggressive cancers have already taken flight before you can discover them, which is why some people still die from cancer, despite early detection. And lots are more like turtles. They aren’t going anywhere. Removing them won’t make any difference. >Over the past two decades, we’ve tripled the number of thyroid cancers we detect and remove in the United States, but we haven’t reduced the death rate at all. In South Korea, widespread ultrasound screening has led to a fifteen-fold increase in detection of small thyroid cancers. Thyroid cancer is now the No. 1 cancer diagnosed and treated in that country. But, as Welch points out, the death rate hasn’t dropped one iota there, either. (Meanwhile, the number of people with permanent complications from thyroid surgery has skyrocketed.) It’s all over-diagnosis. We’re just catching turtles.
DanBC 9y ago
They do cause harm. People find all kinds of lumps and shadows when they get an MRI done. So now they have this thing, no-one knows what it is, and the patient has to decide whether to just live with it or have a biopsy to find out what it is. The biopsy carries a risk of harm. And then you get the results of the biopsy. But that's not always clear. Maybe they find cancer. So, is it a rapid cancer that will kill you if left untreated? Or is it a slow growing cancer that's just going to sit there not doing much until you're 93? The treatment can be harsh and cause harm. Here's some articles. (Note how old these are. This isn't new advice). http://www.bbc.co.uk/programmes/articles/15g8LGyBzYvMHpq6qNh0kBM/should-i-get-a-full-body-screening http://www.bbc.co.uk/programmes/articles/15g8LGyBzYvMHpq6qNh... > The first problem she uncovers is that detailed but general scans, such as a full body MRI or CT scan, can frequently bring to light small abnormalities which have no implications for health at all. They are the equivalent of tiny moles, freckles or scars on the outside of our body. Yet if they are picked up on a scan, then they can cause worry and further, much more invasive, testing – usually for no reason. > The second problem that she uncovers is that even for some very specific tests, such as ultrasound of the arteries to assess the risk of stroke, the treatment available to rectify any small issues found carries very high risks to the patient. In the case of the ultrasound of the Carotid arteries in the neck, surgery to help clear any blockages would not be advised unless the patient had already had a stroke, or mini-stroke, making a test on an otherwise healthy person pointless. http://www.independent.co.uk/life-style/health-and-families/health-news/the-1631000-body-scans-that-ought-to-come-with-a-health-warning-2008808.html http://www.independent.co.uk/life-style/health-and-families/... > An American patient who had a whole body scan described how it threw up an early warning of lung cancer. He had a lung biopsy after a nodule was detected but it turned out to be a healed scar, posing no threat. However, the investigation involved four days in hospital, a painful procedure, several weeks of recuperation - and a $47,000 (£25,000) bill at the end. http://news.bbc.co.uk/1/hi/health/7150583.stm http://news.bbc.co.uk/1/hi/health/7150583.stm > "Full body MOTs" may often find benign abnormalities - so-called false positives - while missing real problems, said Professor Nicholas Wald, a specialist in preventive medicine.
ryanianian 9y ago
The rate of false-positives is almost always non-zero. So having an MRI scan may show a problem that doesn't actually exist. I think I remember seeing something about not doing mammogram and/or prostate screenings too often, lest they find a false-positive and do a whole bunch of followup tests and procedures that in turn keep widening the risk for complications.

What's the problem with full body MRI scans for healthy people? They don't cause any harm, just cost money.

by s3nnyy 9y ago

What's the problem with full body MRI scans for healthy people? They don't cause any harm, just cost money.

CaptainZapp 9y ago

Apart from the fact that it costs a lot of money. What do you want to achieve with a full body MRI scan?

s3nnyy 9y ago
A friend of mine who wasn't even 30 years old had a serious brain tumour where they said "ouh, if we'd had done a MRI scan some years ago, it would have been much easier to fix." So that is why it might be a okay'ish idea to do a MRI scan of the brain every 5 years or so? Depending where you live they are actually cheap and can be paid out of pocket.
- CaptainZapp 9y ago
  Fine and fair enough. But that scan would be limited to the head and not cover the entire body. I'm also not convinced that MRIs are a great, general purpose diagnostic tool, if it's not used to diagnose concrete issues. The experience of your friend, who I hope recovered from the tumor not withstanding.
- FireBeyond 9y ago
  With those caveats in place, absolutely. In the US, studies have been shown that physicians who own shares in CT (not so much any more, as it becomes almost 'commodity') and MRI (which is a lot, manufacturers approach physicians to form imaging cooperatives) are ordering imaging up at more than 2 standard deviations from expectations. As noted, MRIs in themselves aren't harmful. But with prices in the four digits in the US... you can easily pay off your $1.5M MRI machine in 18 months and be printing money with your over-imaging.

jartelt 9y ago

MRIs should be safe. It's the unnecessary CT scans you want to avoid. Those blast you with x-rays and increase your risk of cancer by a non-negligible amount.

astura 9y ago
MRIs on healthy, asymptomatic individuals are not "safe," they cause harm due to overdiagnosis and overtreatment. I know TFA was a long read but it explains it, CTRL-F "turtle" to get to the part about tumors specifically. Here's a similar explanation: https://sciencebasedmedicine.org/a-skeptical-look-at-screening-tests/ https://sciencebasedmedicine.org/a-skeptical-look-at-screeni...
- jartelt 9y ago
  Agreed - I was simply stating that the act of getting an MRI does not cause harm, whereas some other tests (CT scans, X-rays, etc.) actually cause harm during the course of the test. I certainly would not recommend healthy people to get MRIs. But if something is really messed up in your body, an MRI is one of the safer imaging techniques (albeit expensive and not always the best for the job).
Omnus 9y ago
Not really. The absolute worst estimates for CT scans increasing your risk of fatal cancer is around 1 in every 2,000 scans. That statistic almost certainly isn't true, since we'd see skyrocketing cancer rates since the development of CT scans, which we haven't. But even assuming it was true, that's pretty close to a "negligible" risk. 1 in 5 people will die from cancer. That's 400 out of 2000. Getting a CT scan makes your risk 401 out of 2000 in the worst possible scenario. If anything, that's an argument for more CT scans (as long as they're necessary or preventative), especially if you're at risk for certain types of cancer and could detect it early with preventative scans. MRIs would be better in that case, but you aren't going to die from a CT.

astura 9y ago

They cause harm due to overdiagnosis and over treatment. https://sciencebasedmedicine.org/a-skeptical-look-at-screening-tests/ https://sciencebasedmedicine.org/a-skeptical-look-at-screeni...

paulsutter 9y ago
Scans don’t cause overdiagnosis. Eager checklist-driven doctors cause overdiagnosis. You will see incidentalomas, how you use that information is not preordained.
- astura 9y ago
  Scans directly cause overdiagnosis. It's very non-intuitive but scans and tests have the potential to cause more harm than good. From TFA: >Overtesting has also created a new, unanticipated problem: overdiagnosis. This isn’t misdiagnosis—the erroneous diagnosis of a disease. This is the correct diagnosis of a disease that is never going to bother you in your lifetime. We’ve long assumed that if we screen a healthy population for diseases like cancer or coronary-artery disease, and catch those diseases early, we’ll be able to treat them before they get dangerously advanced, and save lives in large numbers. But it hasn’t turned out that way. For instance, cancer screening with mammography, ultrasound, and blood testing has dramatically increased the detection of breast, thyroid, and prostate cancer during the past quarter century. We’re treating hundreds of thousands more people each year for these diseases than we ever have. Yet only a tiny reduction in death, if any, has resulted. >H. Gilbert Welch, a Dartmouth Medical School professor, is an expert on overdiagnosis, and in his excellent new book, “Less Medicine, More Health,” he explains the phenomenon this way: we’ve assumed, he says, that cancers are all like rabbits that you want to catch before they escape the barnyard pen. But some are more like birds—the most aggressive cancers have already taken flight before you can discover them, which is why some people still die from cancer, despite early detection. And lots are more like turtles. They aren’t going anywhere. Removing them won’t make any difference. >Over the past two decades, we’ve tripled the number of thyroid cancers we detect and remove in the United States, but we haven’t reduced the death rate at all. In South Korea, widespread ultrasound screening has led to a fifteen-fold increase in detection of small thyroid cancers. Thyroid cancer is now the No. 1 cancer diagnosed and treated in that country. But, as Welch points out, the death rate hasn’t dropped one iota there, either. (Meanwhile, the number of people with permanent complications from thyroid surgery has skyrocketed.) It’s all over-diagnosis. We’re just catching turtles.

DanBC 9y ago

They do cause harm. People find all kinds of lumps and shadows when they get an MRI done. So now they have this thing, no-one knows what it is, and the patient has to decide whether to just live with it or have a biopsy to find out what it is. The biopsy carries a risk of harm. And then you get the results of the biopsy. But that's not always clear. Maybe they find cancer. So, is it a rapid cancer that will kill you if left untreated? Or is it a slow growing cancer that's just going to sit there not doing much until you're 93? The treatment can be harsh and cause harm. Here's some articles. (Note how old these are. This isn't new advice). http://www.bbc.co.uk/programmes/articles/15g8LGyBzYvMHpq6qNh0kBM/should-i-get-a-full-body-screening http://www.bbc.co.uk/programmes/articles/15g8LGyBzYvMHpq6qNh... > The first problem she uncovers is that detailed but general scans, such as a full body MRI or CT scan, can frequently bring to light small abnormalities which have no implications for health at all. They are the equivalent of tiny moles, freckles or scars on the outside of our body. Yet if they are picked up on a scan, then they can cause worry and further, much more invasive, testing – usually for no reason. > The second problem that she uncovers is that even for some very specific tests, such as ultrasound of the arteries to assess the risk of stroke, the treatment available to rectify any small issues found carries very high risks to the patient. In the case of the ultrasound of the Carotid arteries in the neck, surgery to help clear any blockages would not be advised unless the patient had already had a stroke, or mini-stroke, making a test on an otherwise healthy person pointless. http://www.independent.co.uk/life-style/health-and-families/health-news/the-1631000-body-scans-that-ought-to-come-with-a-health-warning-2008808.html http://www.independent.co.uk/life-style/health-and-families/... > An American patient who had a whole body scan described how it threw up an early warning of lung cancer. He had a lung biopsy after a nodule was detected but it turned out to be a healed scar, posing no threat. However, the investigation involved four days in hospital, a painful procedure, several weeks of recuperation - and a $47,000 (£25,000) bill at the end. http://news.bbc.co.uk/1/hi/health/7150583.stm http://news.bbc.co.uk/1/hi/health/7150583.stm > "Full body MOTs" may often find benign abnormalities - so-called false positives - while missing real problems, said Professor Nicholas Wald, a specialist in preventive medicine.

ryanianian 9y ago

The rate of false-positives is almost always non-zero. So having an MRI scan may show a problem that doesn't actually exist. I think I remember seeing something about not doing mammogram and/or prostate screenings too often, lest they find a false-positive and do a whole bunch of followup tests and procedures that in turn keep widening the risk for complications.