Better safe than sorry?

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Official opinionLast year the Department of Health responded to the purported rise in opportunistic screening by asking the radiation safety watchdog to look at the issue of unregulated computed tomography (CT) screening for asymptomatic people offered by the private sector. A report from the Committee on the Medical Aspects of Radiation in the Environment (COMARE) has been expected since the summer and is currently awaiting approval by ministers. It is expected to be published early next year.Although its contents cannot be predicted, the report is unlikely to recommend CT screening as a means of delivering better public health. Gill Markham, vice president of the Royal College of Radiologists, who sat on the COMARE subcommittee which produced the report, said that the basic message is that targeting asymptomatic people for computed tomography screening “is not on.” The college has seen more complaints from the public about private sector screening in recent months and she admits it is an increasing problem.The US Food and Drug Administration does not recommend CT screening. Backed by the American College of Radiology, the American College of Cardiology/American Heart Association, the US Preventive Services Task Force, and others the FDA says that it “knows of no data demonstrating that whole-body CT screening is effective in detecting any particular disease early enough for the disease to be managed, treated, or cured and advantageously spare a person at least some of the detriment associated with serious illness or premature death.” It adds that “the harms [from scans] currently appear to be far more likely and in some cases may not be insignificant.”1Although the statement was last updated in 2005, Paul Allan, consultant radiologist at the Royal Infirmary in Edinburgh, says there is no new evidence that would justify any changes. While there are few documented benefits of CT screening for people with no symptoms, there are known drawbacks. In a review for the Royal College of Physicians of Edinburgh and the Royal College of Physicians of Glasgow in 2004, Dr Allan pointed out that, “With the production of impressive 3-D reconstructions and other fancy techniques it is easy to forget that relatively high doses of radiation are used in the production of these images.”2