Early last week, a mobile MRI van pulled up to the steps of Capitol Hill. Operated by the Brain Tumor Foundation, the MRI on wheels offered free brain scans. About 60 asymptomatic persons, including six legislators, took up the offer and were scanned for brain tumors. This was the first leg in the Foundation's Road to Early Detection campaign, launched by its founder and president, Patrick J. Kelly, MD.
Screening and early detection are generally thought of in positive terms; however, Dr. Kelly's ambitions to screen people across the country is not without critics, many of whom contend that Kelly's mobile MRI screening--without the use of a contrast agent--is without scientific merit. Dr. Kelly, a prominent neurosurgeon who says that he holds the world record for brain tumor operations, some 7,300, is unabashed in his belief that widespread screening will save lives.In his view, there are many people walking around with asymptomatic brain tumors in a quiescent state that should be detected and followed with serial MRIs.
But his critics make the point that without proper sequencing and the use of contrast agents, many brain lesions will remain undetected. In a statement, Otis Brawley, MD, Chief Medical Officer of the American Cancer Society cautioned that in a time of economic stress, we need to be circumspect in using screening techniques that could lead to costly and perhaps unnecessary treatments. In short, he stressed that there are no data to support Kelly's initiative. "We don't have any of these things [trial-driven data] in the case of brain tumors," said Dr. Brawley.
Jokes about politicians needing their heads examined aside, Dr. Kelly's Road to Early Detection campaign is an opportunity to open an important dialogue about how we use our valuable and thinly stretched health-care dollars. Early detection is the mantra in cancer care, but unless our techniques are based on solid evidence [this blog will closely follow the comparative effectiveness initiative] early detection can come at prohibitive cost to society, both in outcomes and dollars.