Pros and cons of self-referral CT screening

So, the Advertising Standards Authority (ASA) have upheld complaints by two doctors against TV adverts promoting the services of Lifescan, one of an increasing number of companies offering self-referral CT screening. As a radiologist with a particular interest in radiation protection, I ought to welcome that ruling, and I do, but with just a slight feeling of unease.

What the ASA didn’t like was the use of phrases like ‘an MOT for the body’ which would give clients ‘peace of mind’, the implication being that the all-clear from Lifescan meant that you were free of disease. They also objected to viewers being given the impression that screening for lung and colon cancer and osteoporosis was appropriate for all asymptomatic individuals over the age of 40, which is at variance with the evidence base as summarised in the recent COMARE report. 

They were less impressed by the argument that these screening examinations uncover a large number of incidental findings which trigger expensive further investigation, at NHS expense, with no benefit to the patient. That will be a disappointment for our colleagues in general practice, who get fed up with patients who arrive waving their ‘MOT report’ and demand specialist referral.

So yes, I’m pleased with the ruling, because there’s no doubt that unnecessary radiation exposure resulting from the unregulated growth of these companies could have a significant detrimental health effect for clients, not to mention the economic knock-on effect for the NHS. But we have a baby and bathwater situation here. Although indiscriminate whole-body scanning is undoubtedly a bad thing, we know that the targeted use of screening can be a force for good, and as the evidence base is built up, it may make sense to extend screening services within the NHS.

Note I said ‘within the NHS’. That’s not because I object to radiology colleagues making a few quid in the private sector - indeed, you could argue that the evidence for and against screening for particular conditions may come partly from early adopters outside the NHS. The problem is, of course, that relatively expensive private screening only benefits the worried middle classes, and fails to reach those sections of society most likely to benefit from it. It would therefore be a pity if the ASA ruling adversely affected the public’s already fragile understanding of the role of screening.

The ruling has been discussed in the forums on DNUK. One contribution, from a radiologist, raised the issue of regulation of CT screening companies under the ionising radiation regulations, bemoaning the fact that the Royal College of Radiologists (RCR) was a weak organisation that failed to police private imaging companies. He or she had of course got completely the wrong end of the stick, as people so often do when slagging off their own royal college. The RCR, like all the other colleges, is an educational charity, not a trades union or a regulator. However, they do provide advice to the inspectorate which enforces the legislation, and I would be very surprised if they (the inspectors) don’t have private CT screening companies well and truly in their sights.

Tags: CT screening