Economic impact of false positives in cancer screening.

[teresag]

From http://www3.proteomicssurf.com:443/foru ... adid=11917

A study of the economic impact of false positive screening tests for cancer.

They did not attempt to measure the emotional distress associated with false positives. The statement about nomedical costs incurred by lung ca screening pts. is interesting. I doubt they tried very hard to measure nonmedical costs like transportation and meals at the hospital cafeteria.

Excerpt:

Forty-three percent of the study sample incurred at least one false-positive cancer screen. The majority of these patients (83%) received follow-up care. Prior to and after controlling for participant characteristics, significantly higher medical care expenditures in the year following screening were found among those with a false-positive screen. The adjusted mean difference was $1,024 for women and $1,171 for men. Among lung cancer screening patients, few nonmedical care costs were identified beyond the time (mean, 1.5 hours) spent receiving care.

The study was funded by the National Cancer Institute and is part of a larger trial of the effectiveness of screening for prostate, lung, colorectal and ovarian cancers.

[kimblanchard]

This hits a nerve with me. Their study is limited to the costs of resolving the false negative. The fact is early detection results in a higher cure rate. I was diagnosised at age 45 with Stage IV nsclc with a single met to the brain. I have been a lifelong non-smoker. Till this day, I remain completely asymptomatic. As I review my EOB forms from my insurance company, I clearly on the way to becoming the million dollar woman. That is just my treatment cost. When I think of the costs that my family will have to bear if I die early, it just starts to get ridiculous because my husband will probably need to hire a nanny to help care for our eight year son and with the housecleaning.

When the medical establishment finds a drug that gives a 30% response rate, everyone gets excited because another effective treatment has been found. Don't get me wrong. I am excited to because these drugs keep me well and enable me to live my life. I gladly pay $1000 to resolve a false negative than the thousands of dollars that I have spending on medical costs for the past 2.5 years. We need to use the screening tool and we need to identify better risk factors for smokers and non-smokers since we know that the disease is different for these groups. This is not a older persons disease and critieria for screening needs to address this issue also.

Too many times this disease is found by accident and I find this to be unacceptable.

[Jana_W]

Hi Little Mo

I agree very strongly with you. I always get quite distressed when I read that lung cancer screening via imaging has not been recommended as a screening tool. I suspect this is an economic reason, in that it costs the government more to implement a mass screening program than what they forecast they will save by these earlier detections. Is that really the issue?????? Saving lives should be an important issue too. Early detection is always going to be better surely.

with best wishes

Jana

xx

[kimblanchard]

It is me again. Most importantly, I did not include the non-dollar emotional costs that my family and I have been enduring since the initial diagnosis. I can't imagine the impact to my little boy. I can only hope that we are supportive and honest enough now to help minimize the long term impact. It is very important to us to protect his childhood.

[JaneC]

Little Mo,

I agree 100% with what you said.

I'd like to see the costs related to finding and treating early stage NSCLC versus late stage. I know the amount of money that's been spent on my treatment would have gone a long way in paying for lots of screening.

Also, I wonder has similar studies been done on breast cancer screening?

[teresag]

Good point, Jane. The latest research has questioned whether mammograms improve survival. This is typically the argument against lung ca screening; it costs too much and does not improve survival. It is true that investigating a lung nodule is riskier and more expensive than doing a breast biopsy. The jury is out still. I'm waiting for the results of the NLCST - national lung cancer screening trial - in a few years to tell us if CT screening for high-risk individuals works.

[karenl]

Call me crazy, but I do NOT understand how screening high-risk individuals for lung cancer WOULDN'T work. My Mum, for eg, took it upon herself to have annual chest x-rays, following throat cancer in 1986. Now, unfortunately, the radiologist missed the tell-tale spot on her lung in her 2002 x-ray, and hence we are where we are today. Had he been paying enough attention when reading that x-ray, then I suspect that things might have turned out quite differently.

Sure, there is the cost of 20 or so x-rays over the last 2 decades, but that cost pales into insignificance when compared to the cost of treating Mum's advanced disease.

I wonder whether the pharmaceutical companies would be supportive of these screening tests for early detection? Somehow I think not. (No offence to Peggy's husband, or anyone else who works for one of them ).

Karen

[daggiesmom]

I go to a major Cancer Center in NYC for my wonderful care. I see signs everywhere for Early Lung Cancer Screening as a way of detection . It seems that the earlier lung cancer is seen, the sooner it can be treated. I think that ALL insurance companies should cover yearly CAT scans for people who request them. It would save lives, and also, in the long run, save the insurance companies money. To me, it seems to be a win-win situation. Why doesn't that happen? If it's a question of money, which it probably is, then it should be funded from the tobacco money settlements.

Am I wrong or missing something here?

Joanie

[teresag]

The hard part about lung cancer screening is that all people, especially as we age, have "spots" on our lungs. Scar tissue, calcifications and infections can all appear as lesions on a simple chest x-ray. A CT scan cannot tell whether a lesion is malignant or benign either. And if the lesion is small, it won't light up on a PET scan. PET scans are also not specific to cancer, as you know - they light up for any inflammatory process. By far, most lung spots are benign and of no significance. Thus the attitude of "wait and see if it grows" when a lung spot is found on screening, especially if the risk of lung cancer is low (e.g. non-smoker without family history and no home or occupational exposure to toxins.)

Doing a biopsy of a lung spot is not as simple as doing a breast biopsy, for example. As you probably know, trouble spots are not always accessible by bronchoscopy or externally through the chest wall, which means surgery. Anytime you go through the chest wall & into the lung, you puncture the pleura, which collapses the lung. Locating the lesion to biopsy it with a skinny little needle can be tricky and the patient usually has to be sedated, which carries its own risks. Then there is the risk that the tissue obtained won't be diagnostic anyway, despite best efforts to get a "good" sample. Add to that the fact that high-risk individuals often have other medical problems, e.g. heart disease and emphysema, and you see why screening and biopsying lung nodules is very complex.

This is a very difficult problem, and clinicians and scientists have been trying diligently to solve it, but it defies any simple solution. I suspect that high-risk people may benefit from screening, but the studies so far have been mixed. Although it seems logical that screening would be cost-effective and improve survival, so far the research has not shown that.

This was the impetus behind the National Lung Screening Trial; to get some answers to this very hard problem. They enrolled 50,000 people who will be followed for 5 years - enrollment finished last year, so we will have to wait for a while to see the results.

[karenl]

I agree that 'physical' investigation of a suspicious spot on the lung is potentially difficult. However, if something is detected, then surely it is worthwhile flagging that individual for a follow-up scan in 3 months time to determine whether the spot is growing. I understand that some clinicians might have concerns about the anxiety, perhaps unnecessary, that this might cause patients. If, indeed, most suspicious spots turn out to be nothing, then surely this information can be given to the patient at the time of the initial scan to reduce their level of concern. I reckon most people would take 3 - 6 months of anxiety over a potential death sentence. I know that I would rather spend a few months worrying that I have a very low risk of carrying a malignant tumour which can likely be surgically resected if required due to its early detection. This situation seems highly preferrable to discovering widespread incurable cancer 1-2 years down the track.

I don't mean to sound like I am attacking you, Teresa. I am sure that you are just as frustrated with the situation as the rest of us. The whole system just seems ridiculous to me; I am tired of seeing our member list grow so large.

Karen