False-Alarm Cancer Tests Cost People Big Money, Not Just Peace
of Mind, According to Study
12-20-2004 5:49 PM
By MARILYNN MARCHIONE

It sounded like a pretty good deal to Ken Doerflinger: a government
study offering to scope and probe him tip to toe for signs of cancer.
But those free tests wound up costing the 75-year-old retiree a lot.
By the time it was over, he had had more blood tests, a biopsy of
his prostate, and a colonoscopy _ thousands of dollars of additional
work _ just to prove that he didn't have cancer after all.

Screening tests that turn out to be false alarms can cost people a lot
more than lost sleep. A new study found that people spent an extra
$1,000 or so on health care in the year after a screening test raised
suspicions that later proved unfounded. Much of that was for more
definitive tests to rule out cancer.

"The key here is to make sure that people are considering all the
possible benefits and harms" when they go for a screening test,
especially one that is not recommended by health officials, said
Jennifer Elston Lafata, director of the Center for Health Research at
the Henry Ford Health System in Detroit.

She led the study, which was published in this month's Cancer
Epidemiology, Biomarkers & Prevention, a journal of the American
Association for Cancer Research.

Surveys show that Americans generally have high opinions of screening
tests. Some fear cancer so much that they will even pay hundreds of
dollars for tests that medical experts do not recommend, such as whole
body scans at private scanning centers.

But by their very nature, screening tests are problematic.

"They're not intended to be definitive. They're intended to distinguish
those who don't have cancer from those who might," said Robert Smith,
director of screening for the American Cancer Society.

For some screening tests _ mammograms for women over 50 and Pap smears _
there is evidence that they do more good than harm. But for others, that
evidence is lacking.

Lafata's study involves some of the 154,000 participants in a National
Cancer Institute study designed to determine the value of some of these
tests.

Participants were given chest X-rays for lung cancer and a flexible
sigmoidoscopy exam for colon cancer. Women also were given an ultrasound
exam and a blood test for ovarian cancer, and men were given the PSA
blood test and a digital rectal exam for prostate cancer.

To estimate the cost of false alarms, the study focused on 1,087
participants in the Detroit area for whom insurance records were
available on follow-up care. Costs in the year after a "false positive"
test were compared with costs for people whose tests were accurately
negative.

The bottom line: Men with false positives spent an extra $1,171, and
women, $1,024.

Some experts disagreed with how the study classified costs for "false
positive" sigmoidoscopies, which examine only the lower part of the
colon. If follow-up testing by colonoscopy, which examines the whole
colon, did not find cancer, the initial test was considered falsely
positive and the colonoscopy costs were regarded as excess.

But these tests "really return a dividend" because precancerous growths
called polyps are removed during the colonoscopy, which prevents cancer
and saves money on screening in future years, because it only needs to
be done every three to seven years, Smith said.

Despite this disagreement, cancer specialists agreed with the central
point of the study _ that the imprecision of screening tests takes an
economic toll, not just an emotional one.

"There are a lot of hidden costs, too," such as lost time, lost wages,
and travel and child care expenses that people incur while having
follow-up tests that prove unnecessary, said Dr. Barnett Kramer,
associate director of preventive health at the National Institutes of
Health.

Some women in the study had expensive laparoscopic surgeries to
rule out ovarian cancer, Lafata noted.

Many men had prostate biopsies because of false PSA tests, which
measure a substance made by the prostate. High levels can indicate
cancer but also a host of benign conditions.

Doerflinger was one of those men. His PSA score was 6, above the
level of 4 that usually triggers suspicion. His sigmoidoscopy also
raised suspicion, leading to a colonoscopy, another follow-up
procedure requiring anesthesia.

To his relief, it came back negative for cancer. His insurer footed
virtually all of the bill _ he does not even know how much it all cost.
But those costs ultimately come back as higher insurance premiums.

Kramer had this advice for people considering a screening test: Make
sure there is good evidence that the test works, that the person doing
it is qualified, and that it prevents deaths, not just finds cancer.

Federal guidelines are a good place to start, he said.

___

On the Net:

Federal screening guidelines: http://www.ahrq.gov/clinic/prevenix.htm

American Cancer Society: www.cancer.org

National Cancer Institute: http://www.cancer.gov/cancertopics/screening

The journal article:
http://cebp.aacrjournals.org/cgi/content/short/13/12/2126