Health: I Screen, You Screen

Hank Furman prides himself on wringing the last cent out of a dollar. But when it comes to good health, "no amount of money is too much," says Furman, a 73-year-old retired machinist from Euclid, Ohio. That's why he recently took advantage of a vascular ultrasound screening program advertised in his local newspaper. Furman paid $129 for a battery of tests, none of which was covered by his insurance. The final report: "Everything was perfect," he says. "It gave me peace of mind; that's worth every cent."

But not all doctors agree. The package of screens, offered by several U.S. companies ($129; see lifelinescreening.com), include carotid-artery, abdominal aortic aneurysm (AAA), peripheral arterial disease (PAD) and osteoporosis screens. The good news is these imaging tests can detect abnormalities that could lead to stroke, heart disease and ruptured aneurysms. "We provide a much needed service," says Eric Greenberg, Life Line Screening's vice president of marketing, adding that "significant" vascular disease is found in about 8 percent of clients over 50.

But mass screenings have never been shown to reduce the rate of strokes or heart attacks, says Dr. Steve Nissen, head of cardiovascular medicine at the Cleveland Clinic and president of the American College of Cardiology. "I think it's a bad idea." The U.S. Preventive Services Task Force, a government-appointed panel of independent experts who develop recommendations for screening, doesn't think much of these direct-to-consumer programs, either. False-positive or false-negative results can "lead to more harm than good," with unnecessary, sometimes invasive follow-ups or a false sense that everything is A-OK, says Dr. Ned Calonge, who heads the group. "These screens aren't for everybody."

Unless you're one of the people helped. Rebecca Davis, 48, of Highland, Ind., took advantage of a mass-screening program and was particularly interested in being tested for osteoporosis due to her family history. That test was fine, but a carotid-artery screen showed some abnormalities and Davis was told to see her own doctor immediately. He found blockages, admitted her to the hospital for treatment and today she's doing fine.

It's those stories that make some doctors believe the programs may have some merit. "Do these companies screen some of the wrong people? Absolutely," says Dr. K. Craig Kent, chief of the Division of Vascular Surgery at New YorkPresbyterian Hospital and president of the Society for Vascular Surgery. "But vascular diseases, like stroke or aneurysm, present abruptly, acutely and in a catastrophic way. Some people will be helped." Kent says the major challenge is to determine exactly who those people may be.

Until science shows evidence that mass screening is beneficial, the list is small. This year AAA screening became part of the Welcome to Medicare physical for men ages 65 to 75 who have smoked at least 100 cigarettes in their lifetimes and individuals with a family history of AAAs. The task force advises against routine PAD screens and is currently updating its recommendations for carotid-artery stenosis screening (see www .ahrq.gov/clinic/uspstfix.htm).

If you choose to get tested, be smart about it. If you have risk factors like diabetes or high blood pressure, you may want to get screened at age 65 (even if you never smoked), or at age 55 if you have a family history of AAA, says Kent. And, of course, talk to your doctor. While you can't do much about family history or age, you can quit smoking, lose weight, exercise and control your blood pressure and cholesterol—all of which can reduce your risk. And at this point, prevention may be a better choice.

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