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Am Fam Physician. 2002;66(7):1156-1157

to the editor: A 58-year-old, healthy, asymptomatic woman came to our clinic for follow-up after a self-referred computed tomographic (CT) screening examination was abnormal. She came with a detailed report and photographic reproductions from the scan. The report stated that a 3.2-cm, right paratracheal mass was found, likely to be an enlarged thyroid lobe, and recommended further evaluation. The patient was very anxious and upset.

Physical examination revealed no apparent abnormalities; the thyroid gland was normal and the mass was not palpable. Thyroid function studies were all within normal range. An ultrasound of the thyroid revealed a heterogeneous mass in the right lobe, believed to represent goiter formation. Radionuclide scanning of the thyroid revealed moderately increased uptake on the right side. Needle core biopsies of the mass revealed variable-sized follicles and focal stromal fibrosis, consistent with a benign adenomatous nodule.

Regional or full body CT scanning has recently been promoted as a way to provide early diagnosis of cancer as well as cardiac and other diseases. A number of Web sites are devoted to promoting full-body scans. Many sites advertise and promote the procedure based on reports of questionable scientific validity. Proponents cite anecdotal evidence of cancer found at an early, curable stage, or early detection of coronary artery disease allowing for intervention before myocardial infarction.1 Unfortunately, no studies exist to support the usefulness or cost effectiveness of CT screening on an unselected, asymptomatic population. The U.S. Food and Drug Administration and the American College of Radiology have both concluded that there is no scientific evidence to support such screening.2,3 As our case illustrates, a great deal of extra investigation along with significant anxiety for the patient, cost, and morbidity, may be required to prove that an incidental finding on CT screening is exactly that.

There is no way of determining how many persons have had such scans; one company claims to have performed over 15,000 scans.4 With heavy media and Internet exposure emphasizing glowing individual reports of the benefits of this screening, public demand for these procedures is likely to increase. Family physicians should be aware that their patients may have had or are considering such testing. Self-referred CT screening among the general population raises far more questions than answers. Controlled clinical trials are needed to assess the risks, benefits, medicolegal issues, and total costs involved (including false-positive and false-negative findings). We believe that family physicians should actively discourage self-referred CT screening until better information is available.

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This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

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