Full Body Scans: A Silver Bullet in Preventative Health?
Full-body scans have gained in popularity over the last couple of years, not without controversy. We're exploring the current landscape, pros and cons of this new category in preventative health.
Once reserved to the ultra rich longevity clinics or a product only doctors could prescribe to themselves, full-body scans have been gaining in popularity over the last couple of years. New providers and offerings have popped up, and consumer demand for them is rising sharply: last December, there were close to 70K Google searches on terms related to full-body scans. These scans are emerging as a brand new category in preventative medicine, and their democratization is under way — not without controversy.
Are full-body scans the future of preventative health & early disease screening? I’ve spent the last few months researching the field and talking to a number of specialized doctors — radiologists, functional health experts, and oncologists (as well as undergoing a whole body scan myself) about this emerging category. This article summarizes the current landscape, explores the scan’s pros and drawbacks, and discusses whether or not they are a silver bullet in preventative care.
Disclaimer: I am not a medical professional and this article is not medical advice. However, its medical review was conducted by Daryl Eber, MD — a board-certified fellowship trained Diagnostic Radiologist and leading expert in whole-body MRI and screening CT for accuracy and reliability.
The Democratization of Full-Body Scans
What’s a full-body scan? ChatGPT comes back with a decent answer: “Full-body scans are non-invasive imaging tests that are used to screen and detect any abnormalities or potential health risks in various organs and tissues throughout the body. They use advanced technologies, such as magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography (PET), to produce detailed images of the inside of the body.”
Until recently, these types of scans were relatively exclusive, offered in luxury longevity clinics and check up centers as part of extensive health check ups — therefore reserved to the few pockets of individuals who could afford such expensive, proactive care. But that’s changing: full-body scans are popping up everywhere, and are being made more broadly accessible.
Here are the few factors fueling their democratization:
Product Standardization
Full-body scans used to be designed very differently from one provider to the next — as they are composed of various factors such as the breadth of organs scanned, the type/quality of machines, time spent screening each organ, etc. However, recent entrants in the industry, such as Prenuvo and Ezra, have revolutionized the process by creating a standardized product that is both simple and affordable: these scans are performed under an hour, screen for major diseases, have a consistent pricing structure and don’t require direct interaction with a doctor (a centralized physician can read the results asynchronously). While this standardized approach has made it easier for patients to understand the benefits of the scan, it also creates potential issues that will be addressed in this article.
Accessibility
The growth in demand for full body scans has created a virtuous cycle, where an increasing number of companies are offering the service, further fueling demand. This trend has been largely driven by startups such as Prenuvo, Ezra, or Q Bio, which have made significant contributions to the creation of this new category and driven demand through aggressive advertising. By providing accessible and affordable options for consumers, these companies have spurred radiology centers to follow suit, resulting in even more options for consumers.
Pricing & “affordability”
The standardization of full body scans has not only made them more accessible but has also resulted in more affordable pricing. The market leaders, like Prenuvo and Ezra, have set a benchmark price of around $2,500, making this once exclusive service accessible to more people. While the price-tag is still hefty, it seems it’s in line with the perceived benefits of the scans for consumers (namely: peace of mind to know what’s happening inside your body).
The standardization and broader accessibility has fueled controversy over the last few months — with some deeming these scans “bogus”, others deeming that their drawbacks justify that they shouldn’t be rolled out to the general population. The reality seems to sit a little bit in between.
Let’s dive in.
“Get Answers Right Away”
If longevity clinics’ standard offerings include full-body scans, and many doctors admit to prescribing it for themselves and their family, not to mention a majority of concierge doctors who prescribe it to their patients, it’s clear that many physicians see obvious medical benefits.
“ Performed under proper medical supervision and with the newer-generation machines, whole-body scans are an effective tool in providing extensive, actionable medical insights for patients and doctors “ — Daryl Eber, MD — Founder, 3T Radiology & Research
First, MRIs and CT scans are the only screening solutions that visualize anatomy and give insights into physiology that allow patients and physicians to know what’s “actually” happening inside the body across all major organs, bones and tissues. This level of detail, accuracy and breadth of insights cannot be achieved through other screening methods (such as ultrasounds, which have limited screening capacities due to structural constraints). MRIs and CTs do give a million of data points and a unique, tailored view of anyone’s body that’s critical in detecting or preventing serious and chronic health issues.
This leads us to the second major benefit of full-body scans, which is that they uniquely can detect many things at once. What things, exactly?
Cancer. Not all cancers (we’ll speak to some major limitations in cancer screening below), but cancerous tumors that are big enough (generally 1.0 cm+) across multiple organs of the chest, abdomen and pelvis, many of which are not routinely screened for cancer today.
A wide range of heart conditions, including coronary heart disease, the #1 cause of mortality ahead of cancer. Thanks to advancements in AI software, some CT scans are now able to predict in advance when somebody will have a heart attack.
Early signs of dementia. Dementia detection is complex and multifaceted, however brain scans can show abnormal volume reduction in certain areas of the brain (especially the hippocampus) which can be signs of dementia, in particular Alzheimer’s.
Inflammation. One of the newer unique capabilities of MRI is the ability to quantify and detect inflammation in the body, which can be a precursor to a wide range of diseases, including cancer. Which means that full-body scans are not just good at looking at life-threatening diseases, they can also give insights into a patient’s overall health, also known as morbidity. For example, MRI can detect a fatty liver and inflammation in the liver that are correlated with diabetes and cardiovascular disease.
Various vascular pathologies, including potential aneurysms, areas of stenosis or other vascular anomalies: full body scans can analyze risks of developing ischemia or infarcts, including strokes.
Other ‘structural” issues, such as musculoskeletal conditions (most commonly disc herniation or spinal degeneration)
Note that a lot of the controversy around full-body scans has revolved around whether they are effective & needed prevention tools for cancer, but too little has been said around how life-saving they can be in detecting other major life-threatening conditions, such as CAD and aneurysms — especially in asymptomatic and seemingly healthy patients.
So if we summarize the benefits of full-body scans — the combined value proposition of screening for these diseases early and getting actionable intelligence about your anatomy and physiology are unmatched in our current healthcare system. While some medical professionals may push back against them, it’s important to acknowledge that the alternative is imperfect: waiting to take action is not a satisfactory option for many patients.
That said, there are some major limitations to full-body scans.
Not for Everything, Not for Everyone
Full-body scans are powerful, but they are not a silver bullet either: they have major limitations and potential risks — some of which aren’t always disclaimed by the companies who are playing an active role in democratizing them. Let’s get into them:
First, not all full-body scans are created equal — especially when it comes to their precision in early cancer detection. There are many variables in full-body scans, and how scans are designed around them will impact their precision greatly:
MRI vs. MRI + CT — While all full-body scans currently on the market leverage MRIs scans, only some — not all — offer a CT scan alongside it. However, CTs are the recommended method of screening for lung cancer. They also allow for a more detailed look into the nature of plaques in coronary arteries and the inflammation surrounding the coronary arteries — making it a more detailed screening for evaluation of heart attack risk in some individuals.
Reading Methodology — In terms of reading methodology, radiologists typically specialize in specific areas of the body (ie specialty trained). For instance, a radiologist specialized in the brain is likely to read a brain MRI, while a MSK-specialized radiologist is likely to read a knee MRI. As expected, specialized radiologists exhibit greater precision in their diagnoses. So, if you wanted the highest accuracy full-body scan (thus lowering the risk of false positives), you’d want it read by radiologists specialized in each body part. Unfortunately, most of these newly “accessible” full-body scan options are performed by a single “generalist” radiologist — which poses a significant challenge to the quality of the scan (it is important to note that specialized AIs do not currently substitute the need for a specialized radiologist, despite any claims to the contrary).
Scan Timing — It’s kind of obvious: the longer the scan, the higher the quality. Therefore, if a company claims to offer a full body scan that covers major organs in under an hour, it is likely that the scan will be quicker and not as in-depth, and thus may have tradeoffs on image quality and overall scan quality. It is fair to say that the quality of the scan is likely to be inversely proportional to the timing of the scan. It is also worth noting that the newest radiology machines are often more efficient at producing and detecting high-quality images, which may allow for shorter scan times without compromising quality. In short: timing and machine types matter.
Contrast vs. No Contrast — Contrast is a liquid agent that is administered to patients through an IV before an MRI scan to enhance the visibility of certain tissues and structures in the body that may not be visible otherwise. It has been widely used in imaging for years (it is FDA approved and has been implemented for many years in hundreds of millions of patients with no known long term adverse effects) because it acts as a lightbulb and helps differentiate between cancerous and non-cancerous tissues. So full body scans with contrast will have higher accuracy in detecting tumors.
Report — Not all full-body scan providers offer the option of sitting down with a specialized doctor to go through the results. Some companies provide only a basic PDF report that may not provide the necessary context or guidance to fully understand the findings, whereas a doctor can help patients prioritize and interpret the findings, and provide recommendations for next steps if necessary.
So, while full-body scans may seem to be “packaged” similarly, there are many different ways they could be designed, which impacts the quality of their reading, and their medical integrity.
Second, even if the exam had medical integrity, there’s many things it’s still not good at catching, especially certain types of cancers:
Breast cancer. Big deal, it’s women’s #1 cancer. Mammography remains the recommended screening method due to its combined relative overall and cost-effectiveness in detecting breast cancer at an early stage. Recently, significant advancements in early breast cancer detection with MRI have been made, with new protocols and machines proving to be more effective than mammography. However, these next-generation MRI screenings, also known as “Fast-Breast MRI,” are currently only available at select advanced institutions. As a result, “standard” full-body scans may not be as effective as mammography in screening for early breast cancer.
Colorectal cancer — A top cancer in both men and women, and rising sharply amongst young people. For similar reasons, colonoscopy remains the most effective screening methodology for the disease as it allows for the detection of both cancerous tumors and precancerous polyps, which can be removed before they develop into cancer.
Finally, cervical cancer — A Pap smear remains the most effective screening methodology as they are more effective at detecting precancerous changes in the cervix (which can be treated before they develop into cervical cancer) than the MRI.
What we’re saying is that full-body scans may catch certain cancers — but that other, non-imaging-based screening methods are much more efficient at catching major types of cancer early (it’s an entirely separate problem that, despite the fact that these non-imaging methods are “official” and reimbursed, a large majority of the population still doesn’t get screened for them regularly).
Finally, the issue of incidental findings has emerged as a significant challenge associated with full-body scans: they will sometimes detect cancer-like tumors that will need investigation but won’t result in a cancer diagnosis. The scale of these incidental findings is debated:
The widely cited 16% false positive rate reported in many articles is based on a study that has some material limitations: it was conducted on a broad patient population (whereas detection rates may be higher in older patients or those with genetic or medical predispositions), discounts the disparities in full-body scan medical standards that may also affect the accuracy of findings. Many of the current studies that point to the scale of incidental findings have been performed on machines developed in the 90s, so they discount improvements in clinical approaches, hardware, and software that allow for the higher fidelity and comprehensiveness of these scans. Additionally, reporting of these studies was done manually — meaning there is no consistency in their approach. The reality is likely much less alarming, but nonetheless: the risks of incidental findings from full-body scans exist, and conducting the needed workups leading to a diagnosis will impact the patient (physical health, mental health dealing with a potential diagnosis, and financial implications) and the healthcare systems (conducting biopsies / investigating on an otherwise healthy patient).
Certain populations, particularly aging individuals who are more susceptible to diseases, stand to gain greater advantages from undergoing full-body scans: the risk-benefit ratio of full-body scan shifts, with the benefits of early disease detection surpassing the associated costs for these populations.
Therefore, the risk of incidental findings underscores the importance of performing full-body scans with appropriate medical disclaimers, and ensuring that patients are fully informed and prepared to face the implications of such findings. This hurdle may be the most significant factor in determining whether full-body scans are suitable for everyone.
In summary, full body scans are one of the most powerful solutions available today to screen for a lot of major diseases at once. But they’re not a silver bullet: they should be performed with the right medical integrity, come with the right disclaimers about their implications and drawbacks, and recommended alongside other gold standard medical screenings. Although the democratization of full-body scans is subject to debate, they hold the promise of getting more data and information about individuals, leading to life-changing treatments and lifestyle changes. Rather than debating the usefulness of more screening, maybe we should focus our efforts on understanding why our healthcare systems don’t have the capacity for the appropriate findings and follow-ups — whatever the screening methodology.
This article’s medical review was completed by Daryl Eber MD a board-certified fellowship trained Diagnostic Radiologist who is a leading expert in whole-body MRI and screening CT. Dr. Eber founded 3T Radiology & Research and Insite Radiology where he offers state-of-the-art whole-body 3T MRI, PET/CT and CT scans. He is a leader in his field with numerous publications and presentations. He served as a President of the Florida Radiological Society and is a councilor in the American College of Radiology.
Thank you to Anant Vinjamoori (CMO, ModernAge) and Ramin Sahebjavaher (Former VP Technology, Prenuvo) for their valuable insights and feedback as well.