‘False positive’ cancer tests send medical costs soaring

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.

“I thought, ‘Well, if they offer these tests, I’ll take them, free and all,’ ” said the 75-year-old retiree from suburban Detroit.

But those free tests wound up costing a lot. By the time it was over, Doerflinger had had more blood tests, a biopsy of his prostate and a colonoscopy – thousands of dollars of additional work – just to prove 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 issue of 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 even will 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.

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

Lafata’s study involved 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 a 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 spent an additional $1,024.

Some experts disagree 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 then was considered falsely positive and the colonoscopy costs were regarded as excess.

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.