Do full-body MRIs work? Ask your doctor, not Kim Kardashian
Head-to-toe scans appeal to our desire to catch diseases early, but there is no evidence yet that the tests do more good than harm.
In an Instagram post last month that has racked up more than 3.4 million “likes,” Kim Kardashian poses in scrubs alongside an MRI scanner, with a caption alerting her followers to the benefits of “this life saving machine.” She makes clear this isn’t an advertisement for Prenuvo, the company offering the full-body scan she received. But for the stir her post caused, it might as well have been.
Prenuvo, a San Francisco-based startup launched in 2018, is one of several companies that have begun offering head-to-toe scans to anyone willing to pay out of pocket for them. Designed to detect diseases before they cause symptoms, they are pitched to consumers as the ultimate in preventive care.
Prenuvo, which has eight facilities in the US and Canada and plans to open 12 more by the end of next year, has been offering complimentary scans to journalists to give them a look at the technology. And that’s worked out well for them — the company has gotten an incredible amount of attention in recent months. Full disclosure: When Prenuvo approached me about coming into their Chicago office for a scan, my first instinct was, “Sign me up!” After all, what better way to learn about the technology than to experience it first-hand?
But that would fly in the face of everything I’ve learned over the years about health screening.
Our gut tells us that more is always better when it comes to information about our health. But the reality is that with certain tests, the benefits generally don’t outweigh the risks. In fact, the American College of Radiology and other medical organizations don’t recommend full-body MRIs for most people.
Prenuvo and other companies offering similar technology have clearly tapped into a deep vein of frustration that the US health-care system is focused on treatment over prevention. And the accounts of people who believe their lives have been saved by a scan are hard to resist. When I read that a Prenuvo test detected television host Maria Menounos’ pancreatic cancer, my mind instantly shifted to my husband, who has a family history of the deadly disease. Maybe we should shell out the money for a scan?
But that’s the problem: Anecdotes are no substitute for evidence, and right now, anecdotes are all we have. Prenuvo has yet to run any rigorous trials to assess the medical value of its full-body MRIs. That means we don’t know how often the tests reveal something meaningful versus how often they find something vague that causes unnecessary worry and unneeded tests or procedures.
“This is preying on people’s fear of cancer,” says Laura Esserman, director of University of California San Francisco’s Carol Franc Buck Breast Care Center. “I guarantee you that the amount of false positives and crap that they find, what we call ‘incidentalomas,’ that people get anxious over is a magnitude higher than things that they find that are real and important or life-saving.”
And then there’s the potential financial drain. Insurers typically don’t cover the tests, which at Prenuvo start at $999, but can run as high as $2,499. But the cost to a patient might not end with the screening. “We all carry a few anomalies or abnormalities,” says Barry Kramer, who previously served as the director of the National Cancer Institute’s Division of Cancer Prevention. “There’s a substantial likelihood of incidental findings, and then that incurs more out-of-pocket costs” as someone is subjected to more tests to figure out whether a vague finding is harmful.
Consider the challenge (and long-running debate among various medical organizations) of deciding whom, when and how often to screen for breast cancer. Mammogram recommendations have shifted over the years as massive studies better define whom they can and can’t help, and which technologies are most effective. The goal of that research is to help avoid unnecessary and painful biopsies or even mastectomies, while catching the cancers that actually put women in danger. That’s a fine line to walk — one that requires thoughtful studies.
When asked about the need for clinical data to support its offerings, Prenuvo’s founder and chief executive officer Andrew Lacy told me the company is “absolutely focused on collecting evidence,” which he acknowledges will be vital to getting insurance coverage and broader acceptance of the screenings. That would likely first involve demonstrating their value in people who are at high risk of certain cancers.
The question will be what kind of data Prenuvo (and other companies offering this type of preventive screening) will feel compelled to collect. Their inclination might be to look back at the outcomes of their own patients. But that kind of retrospective study has real limitations: The current client base is skewed toward the affluent, a population that likely has access to good preventive health care, and to those pursuing a screening because they are experiencing a mysterious symptom.
The analysis wouldn’t tell us how these tests would perform if widely used in the general population. And even if we’re considering their use in a subset of people — say, those with a higher risk of certain cancers — well-designed studies that follow a group of people over time are the only way to answer the critical questions about when to begin testing and how often to scan.
With the right evidence, it’s entirely possible that these scans could be integrated into our care. The instinct to be proactive about our health is a good one. But in following it, we shouldn’t succumb to a bad one: signing up for unproven technologies.
More From Lisa Jarvis at Bloomberg Opinion:
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This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.
Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, health care and the pharmaceutical industry. Previously, she was executive editor of Chemical & Engineering News.
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