Whole-body MRI not the answer to all ailments: College of Physicians

Quebec College of Physicians raises concerns with full-body magnetic resonance imaging (MRI)

Whole-body magnetic resonance imaging (MRI) is not always the answer to discovering whether a person is suffering from an ailment, according to the Quebec College of Physicians (CMQ) and the campaign Choisir avec soin Québec.

“The Collège des médecins du Québec is responsible for protecting the public and, as such, is issuing an advisory on whole-body MRI scans,” said Dr. Mauril Gaudreault, president of the CMQ.

”In the vast majority of cases, these scans are unnecessary, as scientific data demonstrates. We remind doctors that prescribing them in the absence of specific medical indications (symptoms) runs counter to scientific evidence and is contrary to their ethical obligations.”

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Whole-body MRIs involve an imaging scan that covers the entire body in a single session.

It is presented as a way to “check everything” and detect disease at an early stage, particularly cancer, even in the absence of symptoms.

However, these images are less detailed than a targeted MRI and can often lead to a person requiring further testing.

“It is natural to want to do everything possible to look after one’s health. The idea of ‘checking everything’ may seem reassuring, but in medicine, things are rarely that simple,” explains Dr. René Wittmer, president of Choisir avec soin Québec.

“The use of whole-body MRI as a screening test or health check-up is not recommended for the vast majority of people. The best tests are not necessarily the most sophisticated, but those whose benefits have been demonstrated.”

The College points out that the scans often detect harmless abnormalities, such as benign cysts, minor anatomical abnormalities and age-related changes, and “no study has shown that whole-body MRI improves health or reduces the risk of disease or death.”

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Contrarily, the doctors insist that the scan can “lead to several negative consequences,” including anxiety, unnecessary additional tests (imaging, biopsies, specialist consultations) and medical follow-ups that can be costly and time-consuming.

Additionally, the College argues that readily offering MRIs to patients can reduce access to care for those who actually need it.

“These investigations can also lead to overdiagnosis: the discovery of abnormalities that would never have caused symptoms or harmed a person’s health throughout their lifetime,” the CMQ states. “Once these findings are made, however, it becomes difficult not to take action. This can even lead to unnecessary treatments. In other words, looking too closely can sometimes do more harm than good.”

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A recent study by the Institut national d’excellence en santé et services sociaux (INESSS) found that almost all those screened (up to nine out of 10) resulted in at least one abnormality.

In 15 to 30 per cent of cases, the irregularities led to further tests or consultations, but only one to two per cent of people were confirmed to have cancer.

“No study shows that this scan helps people live longer or in better health, even if an unsuspected cancer is detected,” the College insists. “Undergoing more tests does not mean receiving better care. The best prevention is based on relevant, science-based care that is tailored to each individual.”

As such, the College is encouraging Quebecers not to undergo full-body MRI scans if they are not presenting with symptoms that require it.

“Talk to your doctor if you have any questions about whole-body MRI scans,” the CMQ says. “Tell your doctor about any specific concerns or symptoms you may have and opt for targeted tests, tailored to your personal situation, where medically justified.”

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Though it doesn’t recommend the scan for a generally healthy person, the CMQ maintains that full-body MRIs can be useful in specific situations:

• People with rare genetic conditions that significantly increase the risk of cancer;
• Monitoring of certain known cancers;
• In cases of specific diseases affecting several parts of the body.

In Quebec, whole-body MRIs are available in private clinics and are not covered by the Régie de l’assurance maladie du Québec (RAMQ).