Screening for cancer with computed tomography

Editor—Swensen in his editorial discusses the effect of false positive diagnoses and excessive costs of screening.¹ He describes 700 ancillary findings in a screening study of computed tomography of the body, in which most of these ancillary findings were falsely positive and whose investigation adversely affected quality of life and resulted in unnecessary diagnostic and interventional procedures.

In two tier healthcare systems where public and private facilities run side by side the unnecessary diagnostic and interventional procedures referred to by Swenson will tend to be devolved to the public sector. In my (public) hospital we regularly receive requests for follow up computed tomography scanning on the basis of findings detected at local private screening facilities. The patient, having paid several hundred dollars to find out he or she has a 4 mm lung nodule, rightly or wrongly expects that the healthcare system will now take him or her under its wing and continue follow up of said nodule for an indefinite period yet to be determined by ongoing research. Other expensive strategies, including biopsy, could be applied to a range of common benign liver, renal, and adrenal “incidentalomas” that are detected by high tech multislice computed tomography machines.

The potential costs to any public system are enormous. Despite the statements of regulatory bodies such as the American College of Radiology that there is no evidence base for computed tomography screening of the body, scanners proliferate in our cities and demand from people born in the baby boom is huge. Can our medical systems afford the fallout?