The Brave New World of Health Testing

The "worried well" are doing whatever they can to uncover disease before it takes its toll. But does their detective work yield more questions than answers?

By Susan Ince
It’s especially important to note that full-body scans aren’t specific enough to detect the disease many women fear most: breast cancer.Although mammography is still considered the gold standard for breast cancer detection, another technique, the breast MRI, is being touted by for-profit companies as more effective. While researchers are enthusiastic about the possibility of harnessing the technology in the future to screen high-risk women, there is a high rate of false positives as well as other kinks that need to be ironed out before it’s appropriate for everyone.Unfortunately, some marketers neglect to make that clear in their reassurance-for-a-price appeals. In its promotions, the AmeriScan company disparaged mammograms as a flawed screening tool. That didn’t bother Barbara Brenner, executive director of Breast Cancer Action, a grassroots organization: "Actually, they were saying a lot of what’s true, but not often acknowledged, about mammograms." What made her group dub the company "AmeriScam" was their stating that the $2,200 breast MRIs they offered were any better. The center claimed that "AmeriScan’s revolutionary MRI Breast-Screen is so powerful that no woman should suffer or die from this terrible disease" and that it "can find early breast cancer with nearly one hundred percent accuracy." The company shut down last fall after the San Francisco District Attorney’s Office and the California Medical Board filed suit against it for making false and misleading claims. "There are all kinds of technologies coming out that try to interpret different types of physical information [such as light, sound waves, heat, and the passage of electrical currents] about breast tissue. But these are not ready for prime time and should not replace any established diagnostic test," says Nola Hylton, PhD, professor of radiology at the University of California-San Francisco.Ethicists fear that even more established breast tests are being oversold to women who can’t benefit. Myriad Genetics, creators of the test for the BRCA1 and 2 gene mutations that raise breast- and ovarian-cancer risk, initially sold the test (for up to $2,975) only to oncologists and cancer centers, but later decided to reach out directly to women concerned about their risk. In 2002, Myriad spent about $3 million on a TV and print campaign in Denver and Atlanta, urging women with a family history of gynecological cancer to ask a doctor about testing.Critics feared that doctors unsophisticated in genetics would authorize testing for anyone who inquired, without being prepared to deal with the complex risk information and powerful emotions the results might bring. They also worried that many people would not realize that prevention options lag far beyond the ability to assess genetic risk, and that only 5-10 percent of all breast cancers are caused by mutations to these genes.The ads did result in a five-fold increase in inquiries from those cities, but women tested after seeing the ads had about the same proportion of positive tests as those referred by physicians in other areas, according to Myriad vice president Bill Hockett.What’s Next?Despite reservations among the medical community, we’re likely to have even more seductive choices in the near future.In November, Brain Matters, Inc., opened in Denver, the first in a line of for-profit centers selling brain scans that purport to detect early-onset Alzheimer’s and attention deficit/hyperactivity disorder, sort out a variety of psychiatric problems, or just give you a "brain check" by analyzing blood flow in different regions of the brain. TV ads began running in February in the Denver area.The Alzheimer’s Association notes that such tests, which utilize a technology called single photon emission computed tomography (SPECT), are experimental, and scientists disagree on their value. Assuming SPECT can warn us of impending mental decline, the main avenues of intervention — eating well and exercising — are steps we should be taking anyway."Maybe these are scary, maybe they’re wonderful, but we won’t know without more dedicated work," says Stanford’s Judy Illes.And that’s the reality for many new tests on the market, and on the horizon: We simply can’t know how beneficial they truly are until they’ve been carefully scrutinized and have stood the test of time.

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