Advances in medical imaging and laboratory technologies improve the ability to detect and diagnose disease, leading to earlier diagnosis, more precise treatments, and in some cases improved patient outcomes. When incorporated into medical care for symptomatic patients, these benefits have been widely recognized and covered by insurers and self-insured employers - it’s a different story when similar clinical advances are marketed as preventive screenings to non-symptomatic patients. Enter Multi-Cancer Early Detection (MCED) or full body scans, whose popularity is growing rapidly, particularly among the wealthy.
A recently published Wall Street Journal article discusses this rising health care trend and its implications. While these screenings are marketed to the consumer in a way that seemingly promotes preventive care, many medical experts are voicing concerns about their inefficiency and potential harm. These tests aren’t cheap and are generally not covered by insurance. With full body scans ranging from $650 to thousands of dollars, and the cost of Multi-Cancer Early Detection (MCED) tests around $1,000 - and the follow-up diagnostics necessary to confirm a diagnosis are covered by insurance and expensive. They also yield hefty profits for the hospitals that market these “preventive” screenings.
The Choosing Wisely Campaign in collaboration with the American College of Preventive Medicine released an article discussing six recommendations for appropriate preventive care, of which one urges avoiding the use of whole-body scans for tumor prevention as “there are no data suggesting that these imaging studies will either improve survival or the likelihood of finding a tumor.” These full-body screenings have a high rate of false positives, approximately 16% of cases result in such an outcome. With lesser frequency, in about 2% of cases, these scans have yielded false negatives.
While a single blood test able to detect up to 50 different cancers is appealing. Today there are only a handful of available cancer screening tests. Yet, Multi Cancer Early Detection (MCED) tests are not FDA-approved and do not result in a cancer diagnosis - other tests are needed to confirm the presence of cancer. False positives and false negatives can occur with MCED tests. A 2021 validation study, found the Galleri test had 99.5% specificity, meaning that it was very accurate for determining when a person didn’t have cancer-related signals in their sample. Yet, its overall sensitivity across all types of cancer was only 51.5% - meaning that it correctly identified a little more than half of people with cancer-related signals in their sample. The American Cancer Society states on their website that, “much more needs to be learned before these types of tests can be recommended for widespread use in people without any symptoms of cancer.”
Equity is an important consideration, not discussed. The expense and non-covered status of these screenings, make it likely that utilization will occur among those with the highest income -- and the expense of their follow-up diagnostic services will be socialized across all people in the insurance pool, further driving income disparities. Is this equitable? In the interest of value-based payments, hospitals marketing these screenings could forgo charging for the follow-up diagnostics services, unless cancer is found, in which case the plan would pay for the diagnostic services.
In an economic climate where people are looking to receive the highest value care, non-covered screening can seem appealing, but these scans aren’t consistently reliable or cost-effective. The best way to prevent chronic conditions and their progression is to establish a relationship with a primary care physician and attend routine checkups.
Warm regards,
Louise Y. Probst
BHC Executive Director
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