Washington Post columnist Dana Milbank calls himself "a highly creative hypochondriac" — who just [1]paid for an expensive MRI scan to locate abnormal spots as tiny as 2 millimeters.

He discusses the pros and cons of its "diffusion-weighted imaging" technology combined with the pattern recognition of AI, which theoretically "has the potential to save our lives by revealing budding cancers, silent aneurysms and other hidden would-be killers before they become deadly. "

> But the scans cost $2,500 a pop and insurance won't pay. Worse, for every cancer these MRIs find, they produce a slightly greater number of false positives that require a biopsy, with the potential for infection and bleeding and emotional distress. Even when the scans don't produce a false positive, they almost always come up with some vague and disconcerting abnormality.... Will we feel better after viewing our insides? Or will we become anxious about things we hadn't even thought to worry about?

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> Part of living has always been in the mystery, in not knowing what tomorrow will bring. Now, because of sophisticated imaging, genome sequencing and other revolutionary screening tools, we can have predictability, or at least the illusion of it. But do we want that? The American College of Radiology says we do not. Its [2]still-current 2023 statement says there is not "sufficient evidence" to recommend full-body screening, cautioning that the scan could lead to needless testing and expense. But David Larson, chair of ACR's Commission on Quality and Safety, told me that could change as more data comes in. "When people ask me, 'Would you recommend it?' I would say it depends on your tolerance for ambiguity," he said, giving the example of somebody found to have a borderline aortic aneurysm who is advised to wait and monitor it. If "that won't keep you up at night, then I wouldn't necessarily recommend against it...."

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> About 1 in 20 gets that dreaded call. A [3]study Prenuvo presented earlier this year of 1,011 participants found that 4.9 percent of scans required a follow-up biopsy. Of those, 2.2 percent were actually cancer, and the other 2.7 percent were false positives. Of the 22 cancers the scans caught, 86 percent of patients had no specific symptoms. But if finding something truly awful is rare, finding something abnormal is almost guaranteed. [Vikash Modi, Prenuvo's senior medical director of preventative medicine] said only 1 in 20 scans come back completely clean. The vast majority of patients wind up in the ambiguous realm where something may look suspicious but doesn't require urgent follow-up.

He opted for the cheaper $1,000 torso scan, which the senior medical director calls "our bread-and-butter area," since 17 of the 22 cancers detected in one Prenuvo study were in that area and is where they often find cancers that wouldn't be discovered until they were incurable like "that scary pancreatic stuff...."

Milbank's scan found 12 "abnormalities" included "a 2.5 mm pulmonary nodule in the right lower lobe" and "a 4.6 mm intraductal papillary mucinous neoplasm in the pancreatic tail" — but with 10 abnormalities labeled "minor" (and six being musculoskeletal wear-and-tear problems "I already knew about from the usual aches and pains".)

> Even the two "moderate" findings didn't sound that grim when I read on. The "indeterminant lesion" in my lung requires no follow-up, while the thing in my pancreas is "low-risk."... The "most interesting" finding was the pancreatic cyst, because, at this size and location, there's a 3 percent chance it will become cancerous in the next five years. But if annual follow-up scans of my pancreas (covered by insurance) show it's getting bigger, the cyst can be removed before it becomes cancer. For me, this made the MRI worthwhile. Sure, there was a 97 percent likelihood the cyst never would develop into a problem even if I hadn't learned about it. But now, with minimal inconvenience, I can eliminate that 3 percent risk of getting pancreatic cancer, the [4]most lethal of major malignancies .



[1] https://www.yahoo.com/lifestyle/articles/suspected-hidden-killer-lurked-inside-150044299.html

[2] https://www.acr.org/News-and-Publications/Media-Center/2023/ACR-Statement-on-Screening-Total-Body-MRI

[3] https://aacrjournals.org/cancerres/article/85/8_Supplement_1/7406/760042

[4] https://pancreatic.org/pancreatic-cancer/pancreatic-cancer-facts/