The High Cost of Chronic Conditions: To Screen or Not to Screen

Dr. Cindy Haines Health Guide
  • In March 2010, Richard Ablin, PhD, wrote an opinion piece that was published in the New York Times about the prostate specific antigen (PSA) test that, in recent times, has been promoted as a strategy to catch prostate cancer early. He wrote that ~30 million American men undergo PSA testing each year, at a cost of at least $3 billion dollars per year. Under the headline "The Great Prostate Mistake," he wrote that the test's popularity is directly responsible for "a hugely expensive public health disaster."


    Dr. Ablin discovered PSA, by the way.


    A few months earlier, in October 2009, the chief medical officer of the American Cancer Society, Otis Brawley, MD, was quoted in the Times: "… American medicine has overpromised when it comes to screening. The advantages to screening have been exaggerated."

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    Because finding certain medical problems earlier (or at all) doesn't necessarily mean we'll live longer, healthier lives. And what about the people who underwent expensive, unnecessary biopsies procedures for suspected disease that turned out to be a falsely positive? Or the people undergoing additional surgeries, painful radiation or debilitating chemotherapy for cancers or other diseases that may not have posed a serious threat to their health, or who were knowingly destined to die from something else?


    Let me be absolutely clear: Screening does save lives. Screenings do play an important role in health. Catching a serious disease early in its process can allow doctors to treat the disease more effectively, more cost-efficiently, and with fewer interventions compared to catching it in later stages.


    However, in some cases, catching a disease process early may mean intervention and major decisions when the threat or the solution isn't so clear-cut. In some cases, screening can harm you more than it can help you. And it can end up leading to wasted time, energy, money, and other resources … all without leading to better outcomes.


    Knowing when to use screenings can help ensure that you get the benefits while minimizing the costly drawbacks. In making sure you are getting the best health care in terms of screening, you need to ask questions. Here are some considerations:


    • Talk to your doctor about whether a screening is really right for you, given your risk factors.
    • Ask your doctor how sensitive and specific this test is. How likely is it that the test will accurately pick up the condition screened for?
    • Know that a screening can come back with a false positive. How will you react to the news that you may have what you are checking for? And will this information make any difference in your health management and health outcomes?
    • Realize that screenings aren't harmless. The tests themselves or subsequent testing indicated may cause side effects and complications.


    Bottom line: screen when you should. Just know why you're doing it, and what you are going to do with the result - whatever that may be.


    For even more tips on how to get better health and need the health care system less, check out: The New Prescription: How to Get the Best Health Care in a Broken System by Dr. Cynthia D. Haines, M.D. (Dr. Cindy Haines) and Eric Metcalf, M.P.H. This is a book about getting what you really want: better health on your own terms. 

Published On: October 24, 2012