Screening With Holes in It?
Tuesday, July 19, 2005
It's a cloudy Thursday morning and the fellowship hall of First Christian Church of Falls Church resembles an emergency room. Near the back are four testing areas hidden by white partitions. The patients, mostly older women, shuttle from station to station. Technologists focus on colorful keyboards and blinking screens.
This is one of many such events held regularly by Life Line Screening of America, a Cleveland-based mobile ultrasound company. The firm provides vascular disease and osteoporosis screenings to identify health problems that might otherwise go undetected.
Lucille Ferrante, 84, has been getting screened annually since learning about the service through a story in a community newspaper. "I've been here about five or six times," the Falls Church resident said. The annual screenings give her peace of mind at an affordable price, she said.
A Life Line brochure mailed to homes in the Washington area proclaims, "We can help you Avoid a Stroke . . . in just 10 minutes. . . . You don't have to wait for a medical problem to be screened for your risk of vascular disease or osteoporosis." And the screenings are "fast, painless, accurate . . . [and] affordable," says the brochure. The firm also promotes its services on its Web site, http:/
Locally, the company charges $109 for the three-test "vascular package" and $129 for a "complete wellness package," which adds the osteoporosis test. Neither Medicare nor most private insurers cover Life Line screenings.
The four tests screen for: plaque buildup in the carotid artery of the neck, which can lead to a stroke; an enlarged abdominal aorta, a higher risk for a potentially deadly rupture; peripheral arterial disease, a hardening of the arteries of the leg; and low bone density in the heel, which can indicate the bone-thinning disease osteoporosis.
Life Line is one of many commercial enterprises providing screening services for a fee to anyone who pays. But most operate from fixed locations. Vans based in Baltimore, Richmond and the District visit about 22 locations each month in the Washington area.
Not everyone thinks these tests are a good idea. A federal panel examining the value of such screenings found that the potential harms of the tests -- including negative psychological effects among those testing positive for aneurysms, and false positives, which often result in unnecessary medication and surgeries -- outweighed the benefits of screening for most groups.
Some experts also expressed concern about screening services that do not require patients to have an elevated risk for the conditions they test for. Typical Life Line screening clients have no symptoms and are over age 40, the firm says.
For "people under age 55 without risk factors, the yield [of vascular disease found] is going to be very low," said William Flinn, head of the division of vascular surgery at the University of Maryland School of Medicine and vice chairman of the American Vascular Association (AVA). "A lot of the [commercial] screening is for the wealthy well," he said.
But Andrew J. Manganaro, Life Line's medical director, said it is not unusual for screenings -- such as mammograms and tests for colon and prostate cancer -- to not "require the presence of specific risk factors."
"It is in the nature of the screening process," said Manganaro in an e-mail interview. "This is precisely because of the ubiquitous nature of the diseases for which the screenings are conducted."