Pricey whole-body MRIs don’t add up

For the health conscious or worry prone, whole-body magnetic resonance imaging (MRI) sounds enticing. What better way to protect your body and ease your mind than to look deeply into your tissues and organs for irregularities?

Facilities that offer whole-body MRI promise to screen for hundreds of medical conditions simultaneously. Some use language likening the procedure to a medical crystal ball, showing the future by revealing silent abnormalities that could erupt into life-altering illnesses. 

The reality is more complex. 

In most people, these costly scans detect benign spots, nodules, cysts or other findings that are likely to never cause a problem or need treatment. When it comes to cancer, radiologists at Fred Hutch Cancer Center and UW Medicine advise using targeted, evidence-based screening methods, like mammography and colonoscopy, instead. 

What makes a cancer screening method worthwhile?

“The principles behind a screening test are that it should be relatively inexpensive, relatively accessible and minimally invasive. It should be able to detect cancer before the disease is clinically apparent” — meaning, before a health care provider or patient can see, feel or measure the signs or symptoms — “and it should confer a survival benefit compared to when we detect the disease clinically,” said radiologist Brian N. Dontchos, MD, a Fred Hutch and UW Medicine breast imaging specialist.

To date, no strong evidence supports the idea that whole-body MRI screening improves cancer survival or other health outcomes in people without symptoms. 

Differences in examination techniques across whole-body MRI providers are a concern, said Dontchos. Some companies’ protocols don’t adhere to the standard of care for particular organs. 

“When we use breast MRI at Fred Hutch to screen patients at high risk for breast cancer, we have them lie on their stomach, and we give them intravenous contrast,” as required by the American College of Radiology for accreditation, Dontchos explained. “The breast imaging portion of many whole-body MRI screenings is often inadequate to detect breast cancer because the patient is lying on their back and isn’t given IV contrast.” 

Due to issues like these, Fred Hutch and UW Medicine radiologists don’t offer or recommend whole-body MRI screenings or provide official reinterpretations of whole-body MRIs done elsewhere. 

The potential problems with ‘positive’ results

All this doesn’t mean whole-body MRIs aren’t finding anything. 

A review of 12 studies showed that 95% of asymptomatic patients had at least one “abnormal finding” on a whole-body MRI for cancer screening. But 91% of these findings were not relevant.

Incidental findings frequently lead to visits with a specialist and unnecessary follow-up tests or procedures that consume patients’ time and money, provoke or prolong anxiety and carry risks of their own, like side effects or complications. 

Results of one small study showed that incidental findings from whole-body MRI would have led to dozens of visits to specialists, like urologists, rheumatologists, otorhinolaryngologists (ear, nose and throat physicians), gynecologists and others. 

“People may hope the scan will find nothing and that will be reassuring, which I understand,” said Dontchos.

But research suggests this isn’t most people’s experience.

How to get the right cancer screenings at the right time

Whole-body MRIs run in the thousands of dollars and typically aren’t covered by medical insurance. In those with genetic conditions that raise the risk for tumors in multiple part of the body, like Li-Fraumeni syndrome or neurofibromatosis, a total-body scan might be warranted and covered.

But situations like this are rare, so most people will pay in full out of pocket.

How, then, can a conscientious person be proactive about detecting cancer early? Experts say to rely on tried-and-true methods that are supported by scientific evidence — and normally covered by health care plans (depending on age or other risk factors).

Screenings such as mammograms for breast cancer, colonoscopies or stool-based tests for colorectal cancer, low-dose computed tomography (CT) scans for lung cancer and Pap tests for cervical cancer are widely recommended to find cancer before it causes symptoms. Primary care providers can help patients determine which screenings to have and when, based on their individual risk level and screening guidelines. 

Additionally, Fred Hutch experts will continue to track the results of research on whole-body MRI to see if any meaningful benefits emerge over time. 

“An important part of recommending any screening is understanding its impact on survival,” Dontchos said. “Whole-body MRI screenings haven’t been around a long time, and as a result, we don’t have long-term data yet.”