CR.ORG GUIDE TO WELLNESS 51mammograms fail to find 1 in 5 breast cancers.
Screenings can also pick up harmless abnormalities or
produce false positive results, which incorrectly indicate
the presence of a disease. That can lead to unnecessary and
invasive tests and surgery, which have their own risks.
“The challenge is making sure that people get the right
care,” Krist says. “There are a lot of tests that seem like they
would help you but aren’t backed by any data and can
actually open up a whole set of harms.”A Cautionary Tale
Ron Braithwaite of Portland, Ore., knows that all too well.
Last spring, at age 66, he had a slightly elevated PSA blood
test result. A higher than normal PSA can indicate prostate
cancer, but most often it signifies a noncancerous condition
such as a prostate infection or an enlarged prostate, which
he had lived with for a while.
On his urologist’s advice, Braithwaite had an outpatient
biopsy; a sample of prostate tissue was removed. He knew
there were risks. In one study, 5.6 percent of men who had a
similar biopsy experienced a complication, such as infection,
bleeding, or urinary problems.
Braithwaite’s results were negative for cancer, as they are
for 60 percent of men who have such a biopsy, according to
a 2018 analysis by the USPSTF. Soon after, Braithwaite says,
he developed a high fever. He was hospitalized for six days for
a severe E. coli bloodstream infection, during which the life-
threatening illness damaged his kidneys and heart.
Braithwaite says his kidneys are functioning again, but he
faces a long recovery. His first PSA test was likely his last;
the USPSTF doesn’t recommend it for men ages 70 and older
because the risks of follow-up tests, such as infection, out-
weigh the potential benefits. “It’s a safe bet I won’t get tested
again,” he says.A Surfeit of Screenings—and Costs
Screening has become a big business—worth tens of billions
of dollars—with most of the spending in the mainstream
healthcare system. For example, in 2010 consumers and health
insurance companies spent an estimated $7.8 billion on mam-
mograms alone, according to a 2014 analysis published in the
Annals of Internal Medicine.
Little information is available on how many dollars are
spent nationwide for screening that’s not beneficial. But in
a recent study of health insurance claims from 2.4 million
people in Washington state, the Washington Health Alliance
found that from July 2015 to June 2016, about 26 percent
had at least one test or treatment identified by experts
as unnecessary. That cost consumers and their insurers an
estimated $282 million for the year. Most of the overuse
was due to 11 services, eight of them screening tests. About
$40 million alone went for annual electrocardiograms
(EKGs) and other heart screenings for people at low riskfor cardiovascular disease and without symptoms.
But when screenings are done in accordance with recom-
mendations from major medical organizations, they can
reduce harm and healthcare costs, says Dade, by decreas-
ing the need for expensive treatment for advanced disease.
Early detection and treatment of cancer, heart disease, and
diabetes—which account for 7 of 10 deaths and 75 percent
of healthcare spending in the U.S.—could help more people
survive and pare costs, according to the CDC.
Outside the mainstream healthcare system, however, the
value and cost of screenings gets murkier. And consumers
are increasingly opting to circumvent their doctors for DTC
screenings from for-profit companies. Consumers desire “
a sense of autonomy; they want to take charge of their own
health,” says Ana María López, M.D., M.P.H., M.A.C.P.,
president of the American College of Physicians (ACP). “But
more importantly, it’s become hard to access healthcare
in many places. People may not have a regular physician
they can talk to about their concerns.”
Right now, direct-to-consumer screenings represent a
small but rapidly expanding part of the market. Consumers
in the U.S. spent $15 million on DTC lab and genetic tests in
2010, a figure projected to climb to $350 million by 2020,
according to the market research firm Kalorama. And these
are almost entirely out-of-pocket dollars: DTC tests usually
aren’t covered by insurance. Here, a sampling:
Mobile screenings. Using portable equipment, companies
such as AngioScreen, Life Line Screening, and Matrix Medi-
cal Network offer screenings like EKGs or carotid artery
scans at community centers, churches, hospitals, and work-
places. Life Line, the dominant player, markets bundles
of tests through ads, flyers, and email, and says it screens
almost 1 million people per year at 16,000 events. (^) Online and walk-in labs. Companies such as Walk-In Lab,
Private MD Labs, and Direct Labs perform blood, urine, and
other lab tests of your choice without your doctor’s input.
(In some states, a doctor’s authorization is required.) Walk-
In Lab invites you to “take charge of your health and your
wallet” by ordering anything from a $28 blood-type test to
an $800 “Anti-Aging panel” online.
High-end screening clinics. Companies such as the
Princeton Longevity Center—which bills itself as “the Future
of Preventive Medicine”—market comprehensive screening
options. The executive health exam from Elitra Health in
New York City costs $4,900 and includes a CT coronary
scan and cardiac stress test. Additional services: carotid and
abdominal ultrasounds and full-body CT scans.
(^) At-home or in-store health tests. For these genetic tests, such
as the $199 ancestry and health screening from 23andMe, you
submit a vial of saliva and receive a report outlining your risks
of illnesses like late-onset Alzheimer’s and certain cancers.
Simpler tests, such as cholesterol and blood sugar checks
PH at drugstore clinics and health fairs, may make it easier to
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