Inside the controversial world of full-body health scans: We tested a VC-backed MRI service

There’s a recent trend of venture-backed startups offering full-body MRI scans, promising to help consumers detect potential signs of cancer by paying upwards of $2,500 and laying in a high-tech tube for an hour.

Celebrities such as Kim Kardashian and other online influencers tout the benefits of these companies. One of the startups, Prenuvo, says that 1 in 20 scans result in a potentially life-saving diagnosis. Another company, Ezra, says it has helped 6% of its members identify potential cancer early.

But some medical experts worry that the scans can add unnecessary costs and concerns — in other words, more information about your body could be less helpful than it sounds.

I recently went through the scan process with Ezra, a New York-based startup founded in 2018. The company in February raised $21 million in an investment round led by Amir Dan Rubin, the former CEO of Amazon-owned primary care provider One Medical. Ezra recently launched two new locations in the Seattle region.

Ezra charges between $1,350 to $2,500 for each scan, depending on how many body parts are examined. I did the full-body, 60-minute scan that looks at the head, neck, spine, abdomen, and pelvis. The cost is not covered by insurance; customers can use their FSA/HSA accounts to pay. Ezra covered the cost of my scan for purposes of testing and reviewing the technology for this story.

After completing a short medical questionnaire, I set up an appointment with one of the company’s partner imaging centers.

What’s inside of you?

Ezra tells you how to prepare for an MRI scan, which was helpful for first-timers like me. Once you arrive at the imaging center, you change into Ezra-branded pajamas and slide into the MRI machine.

There was an alignment issue with the MRI table during my initial visit, so I had to return on another day to complete the full scan. Otherwise, the process was smooth, and a few days later I received results from Ezra, which uses AI and FDA-approved image enhancement technology to help produce reports.

Ezra packages all its findings into a digital report on your online profile page. It grades each area of your body with a risk score ranging from 1-to-5:

• 1 means “no follow-up necessary”
• 2 is categorized as “monitoring advised”
• 3 is “non-urgent follow-up”
• 4 is “urgent follow-up”
• 5 means “emergency action”

The company says it can identify more than 500 conditions — everything from fatty liver disease to endometriosis to cancer.

Ezra color-codes different parts of your body based on the risk score and provides detailed explanation of each finding.

There’s also this cool viewing tool (see it in the video above, starting at 4:40) that lets you drag a toggle up and down to see every image taken by the MRI machine.

But I know nothing about radiology, so the tool didn’t provide much value. The report was also filled with medical terms that I didn’t understand. It was difficult to interpret the images and findings.

The report flagged one potential issue that had a risk score of “3,” highlighted in yellow. I was a little worried.

Ezra offers a 1-on-1 video consultation with a medical provider to discuss the report. This is crucial as it’s tough to determine next steps based on report itself, unless you have deep medical knowledge.

The provider went through my results and asked several questions about my own health. We agreed that it was best to flag the report for my primary care provider.

After speaking with my doctor, it didn’t seem necessary to pursue follow-up consultations or tests.

I’m grateful the scan didn’t spot anything too worrisome, and it was good to have more data on my body.

The debate over screenings

There is controversy about the benefits of full-body scans.

Dr. Dhruv Khullar, a practicing physician and assistant professor at Weill Cornell Medicine, wrote in The New Yorker in January, “No professional medical society in America endorses whole-body MRIs as a proactive screening tool.”

The American College of Radiology said last year that there wasn’t enough evidence to recommend total body screening for “patients with no clinical symptoms, risk factors or a family history suggesting underlying disease or serious injury.”

“To date, there is no documented evidence that total body screening is cost-efficient or effective in prolonging life,” the group said in a statement. “In addition, the ACR is concerned that such procedures will lead to the identification of numerous non-specific findings that will not ultimately improve patients’ health but will result in unnecessary follow-up testing and procedures, as well as significant expense.”

Dr. Dushyant Sahani, chair of the University of Washington’s radiology department, told GeekWire that he’d like to see more data from full-body screenings for healthy adults to help determine which patient populations would benefit the most.

Sahani said there needs to be more evidence about the potential for false positives (when a test detects a problem, but you’re healthy) and false negatives (when a test doesn’t catch an actual problem).

People may be wrongly reassured by a false negative, when in reality they have a condition that actually needs to be addressed. Or, in the case of a false positive, they might subject themselves to unnecessary anxiety.

There’s also the cost of “incidental findings” — for example, follow-up biopsies and tests that can create challenges both for the patient and the healthcare system, Sahani said.

“One has to be thoughtful about the unintended consequences,” he said.

Sahani pointed to the huge increase in thyroid cancers in South Korea following widespread screenings that started in 1999. A study published in 2014 pointed to an overdiagnosis of thyroid cancer in the country.

“Cancer experts agree that the reason for the situation in South Korea and elsewhere is not a real increase in the disease,” The New York Times reported in 2014. “Instead, it is down to screening, which is finding tiny and harmless tumors that are better left undisturbed, but that are being treated aggressively.”

Emi Gal, founder and CEO of Ezra, has said he started Ezra because he’s at high-risk for cancer, and he lost his mother to metastatic cancer.

Gal made the case for cancer screening solutions in a blog post earlier this year, pointing to data from the American Cancer Society showing five-year survival rates based on when cancer is detected.

He explained Ezra’s framework for dealing with indeterminate findings — “things that might be cancer, might not, and require follow-up or monitoring.”

“We’ve developed a methodology at Ezra that has enabled us to successfully scale Full Body MRIs to thousands of people without any significant downstream negative effects,” Gal wrote. “This methodology has three components — a scoring system, longitudinal monitoring, and non-invasive personalized follow-up.”

Longitudinal monitoring requires repetitive screenings over time — which is a significant financial commitment, given that Ezra advocates for annual screenings.

Ezra earlier this year rolled out its 30-minute scan for $1,350 and plans to develop a 15-minute scan for $500.

“One of our primary goals as a company is to work to lower the cost of our scans to ensure that more people can access information about their health,” David Girard, chief operating officer at Ezra, told GeekWire via email.

Girard said the company wants to eventually partner with insurers to make scans more affordable.

Ezra has doubled its geographic footprint this year and has more than 60 clinic locations across nine states, with plans to exceed 100 by the end of 2024. The company has raised $41 million to date.

Its main competitor, Prenuvo, has raised more than $70 million and has locations in more than 10 cities across North America. It recently revealed a mobile MRI clinic, launched in part as a response to regulatory headwinds the company is facing in Ontario, Canada.

Would I recommend a scan to you?

It’s actually pretty tough to make a recommendation here.

First of all, I’m not a doctor.

But if you’re a healthy adult and don’t have concerning symptoms, it’s likely not needed — especially given the cost of a screening, and potential follow-ups that may not actually be necessary.

At the same time, there are a lot of anecdotal stories about people who credit these scans for spotting something that needed medical attention.

I’m happy to have more information about my body. The data can be used alongside other tests and conversations with medical professionals. And the user experience with Ezra is pretty seamless.

But there’s a lot you could do with a couple thousand dollars each year to improve your health and help prevent problems.

Maybe one day the price of MRI machines and scans will come down substantially, and we’ll have much more clarity about what the data is telling us about our bodies.

For now, though, my take is that there is too much uncertainty to suggest that these scans should be an annual occurrence for everyone.