The benefits of screening can be huge and are perfectly safe, says DR. THOMAS STUTTAFORD.
The Prime Minister’s support for basic NHS screening is welcome but primary care screening is not a new concept. What is new is Downing Street’s support for it. Routine screening, more extensive than what is now proposed by Gordon Brown, was introduced into the private sector at the end of the 1960s.
Just when the NHS is destined to start basic routine screening a new epoch of private screening is becoming established. Predictably, there has been opposition to it, allegedly because some of the tests involve exposure to radiation as all X-ray and CT procedures do. Possibly some of the opposition may also be related to economic considerations. The more patients learn about their health the more likely they are to demand treatment. It may keep them alive but will inevitably be costly to the Treasury.
Exposure to X-radiation should be avoided when possible. But its potential hazards need to be balanced against the advantages of early diagnosis. Radiation exposure needs to be reviewed against the knowledge that people are subjected to a natural background radiation that exposes a person annually to around 2.5mSv (millisieverts – the unit used to measure radiation). This compares with a single chest X-ray that emits 0.1mSv (only 2 to 5 per cent of the amount in 1975); a routine X-ray at the dentist’s 0.09mSv; and a barium enema (X-ray of the colon) 8.7.
When my children were young, 20 seconds under the shoe-shop X-ray machine when fitting footwear was the equivalent exposure to now having 1,000 to 1,400 hip X-rays.
If Sir Paul McCartney, as was recently reported, had a conventional angioplasty, an X-ray and dilation of the coronary vessels to improve the blood supply to his heart muscle, he will have been subjected to 8 to 10mSv. This procedure may well have been life-saving. Compared with the naturally occurring figures of radiation exposure, or the ones from diagnostic CT scans and X-rays, the amount of exposure involved in screening, if state-of-the art CT scanners are used, is relatively small. MRI scanning doesn’t expose the patient to any radiation. I have personal experience, as patient and doctor, of two well-equipped modern screening centres in Central London. Both Prescan and the European Scanning Centre use the latest technology to reduce exposure to radiation to a minimum. MRI scanning no longer involves entering a giant tube that some people find claustrophobic. I recently sampled the screening services at Prescan’s Harley Centre. The staff were empa-thetic, knowledgeable and communicative. My total radiation exposure during screening was 1.5mSv, under a sixth of the dose emitted during an angiogram.
My screening was rather more extensive than the Prime Minister’s NHS variety. I selected:
-An MRI of the brain and skull. (No radiation.)
-MRI arteries to the brain. (No radiation.)
-MRI of the abdomen and all its vital organs including kidney, liver and pancreas. (No radiation.)
-MRI of the pelvis – includes the prostate for most men but mine has been removed – and the uterus and ovaries in a woman. (No radiation.)
-A CT of the heart including a view of the lungs (1.0 to 1.5 mSv).
The screening also contained blood-pressure measurement, ECG (heart tracing), urine analysis, full blood tests for haematological and biochemical assessment, including a test on liver and kidney function, tests for diabetes, gout and for men the prostatic blood-test profile. It also screens to detect the likelihood of cancer of the colon and rectum. The standard screening doesn’t include smear testing for women.
The total cost of a screening such as mine would be £1,410. Regrettably rather expensive for the NHS but obtaining this potentially life-saving information could be priceless for those who need to arrange their affairs, whether professional or personal. A reliable medical screen is invaluable to selection teams in industry and commerce.
Medicals are comforting to those, even if symptom free, who are approaching the age when disaster can strike. Furthermore, as most of the tests involve no exposure to radiation the screening shouldn’t engender any anxiety.