Study puts annual cost of cancer screening at $43 billion – infosrk.club

The United States spends $43 billion annually on screening to prevent five types of cancer, according to one of the most comprehensive estimates of medically recommended cancer testing ever produced. .

The study, published Monday in The Annals of Internal Medicine and based on data for 2021, shows that cancer screening represents a substantial portion of what is spent each year on cancer in the United States, perhaps exceeds $250 billion. The researchers focused on breast, cervical, colorectal, lung and prostate cancer, and found that more than 88 percent of screenings were paid for by private insurance and most of the rest by government programs.

Dr. Michael Halpern, lead author of the estimate and chief medical officer in a National Cancer Institute-funded health care delivery research program, told his team he was surprised by the high costs, and noted that it is likely to be underestimated due to the limitations of the study. analysis.

For Karen E. Knudsen, chief executive officer of the American Cancer Society, the value of screening for these cancers is clear. “We are talking about people’s lives,” he said. “Early detection gives a better chance of survival. Stop. It’s the right thing to do for the individual.”

“We do cancer screening because it’s effective,” said Dr. Knudsen. “The costs are small compared to the costs of being diagnosed with advanced disease.”

Other researchers said the findings support their claims that screening is overused, adding that there is a weak link between early detection and cancer survival and that money invested in cancer trials well spent.

Colonoscopy is a major source of screening costs, accounting for up to 55 percent of the total. That cost is directed, said Dr. Halpern, with fees charged by the medical or surgical center where the colonoscopy is performed.

Dr. David Lieberman, a colorectal cancer screening expert who speaks for the American Gastroenterological Association, said that although the cost of colonoscopy is high, the test can prevent cancer as well as detect it. The surgeon sees and cuts out growths in the colon wall that can sometimes turn cancerous, thus stopping the cancer before it develops.

The trial has “significant upstream costs and potential downstream benefits,” he said. “

Critics of current screening numbers say the huge price tags charged by researchers for screening aren’t worth the costs.

“What do we really get for that amount of money?” asked Dr. Adewole Adamson, a dermatology researcher at the University of Texas at Austin who studies screening.

“If he gives something I can say, ‘Yes, it’s reasonable,'” he said. But, he said, repeated studies do not show that people live longer if they are screened. And, he says, screening barely reduces the death rate from screened cancers – some cancers are deadly early, and detection may not help.

“People have too much of an idea about the benefits,” said Dr. Adamson.

But screening advocates point to the recommendations of the US Preventive Services Task Force, an independent and influential group that provides advice on preventive health. The organization’s guidelines had far-reaching implications in the United States, setting standards for health insurance coverage. The group did its own analysis of the screening data and suggested it reduced death rates for four of the five cancers in the study, with the strongest evidence for breast cancer and colorectal cancer. For prostate cancer, the group neither recommends nor opposes screening and is currently updating its analysis.

And although screening tests for cancer could be made more effective, advocates of the practice argue that it is still necessary.

“It is unlikely that too many people who are screened will benefit, but many more who could benefit have never been or have not been screened regularly,” said Dr. Knudsen.

He said the “value of screening is proven science.”

Cancer death rates have fallen dramatically in recent decades. Experts debate the reasons, but Dr. H. Gilbert Welch, a senior researcher at the Center for Surgery and Public Health at Brigham and Women’s Hospital who wrote an editorial accompanying the paper, said it would be a mistake to link it alone, or even in the most, to be screened.

With colorectal cancer, for example, death rates have declined linearly for 40 years, falling by nearly 50 percent from the 1980s – when few were screened – to today, when approx. on 50 percent of eligible adults screened. In a previous paper published in the New England Journal of Medicine, Dr. Welch reports that there is no more screening on the acceleration of the decline.

A well-respected clinical trial concluded that screening could reduce the risk of dying from colorectal cancer over 30 years by a third. However, said Dr. Welch, in the study the absolute risk fell from 3 percent to 2 percent – a drop of 33 percent but only one percentage point. And there was no change in the overall death rate with screening.

“I’m not saying that there is no effect from screening, but the effect is so small that something else is going on,” said Dr. Welch. And those, he said, are excellent colorectal cancer treatments and, he speculated, dietary changes and exposure to other factors, such as medications, may reduce the risk.

Lessons from cancer screening, says Dr. Welch, that the effect on mortality “is so small that it would take a large clinical trial to see.” Typically, he said, about one in 1,000 people screened over 10 years avoids dying from that particular cancer.

Dr. Daniel Morgan, who heads the Center for Innovation in Diagnosis at the University of Maryland, said he agrees with Dr. Welch on the limitations of cancer screening.

“I hope the editorial will stimulate a conversation about the true value of screening,” he said.

The question, he said, is, “Should we get screening independent of the cost?”

This problem, said Dr. Morgan, “one we should continue to debate.”