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Five promising screening tests could save your life. But if you want one, you'll probably have to pay for it yourself.
In most cases, the tests -- aimed at finding early-stage ovarian cancer, heart disease, lung cancer and aneurysms -- aren't covered by insurance if you are otherwise healthy and at average risk. But the reason the tests aren't covered or even recommended has more to do with the complexities of national health policy than what may be best for you the individual.
Screening tests are expensive, and the government and health insurers need lots of cost-benefit studies proving a particular test will save enough lives to justify the cost.
Other tests simply don't have political support -- breast- cancer groups have raised awareness of mammograms, but when is the last time your doctor mentioned nuclear magnetic-resonance blood tests?
Finally, no screening test is perfect, and a false positive can lead to additional testing and invasive procedures that can do more harm than good. But while false positives are one reason doctors don't recommend these tests for everybody, you, as an individual, may decide that it's worth the risk.
So here's a look a five screening tests you may want to ask for - - and pay for -- yourself.
Transvaginal ultrasound
Cost: about $250
What's involved: This painless -- though not exactly comfortable -- test uses a wand-like device, inserted into the vagina, to view the ovaries.
There is no approved screening test for ovarian cancer, which kills 14,300 women a year. It's the deadliest female cancer because it often doesn't produce symptoms until it has reached an advanced stage, when five-year survival is as low as 31 percent. Early detection boosts five-year survival to 95 percent.
The best study supporting transvaginal ultrasound comes out of the University of Kentucky, where researchers have screened about 23,000 women over the age of 50 or women over 25 with a family history of the disease.
So far, the screening has picked up about 300 ovarian tumors. Only 29 of those turned out to be cancer, but 76 percent were caught in the early stage, says Jack van Nagell, director of gynecologic oncology at the University of Kentucky Medical Center. Typically only 25 percent of ovarian cancers are caught early.
And the five-year survival rate among women in the Kentucky study is 88 percent -- compared with the national overall ovarian cancer survival rate of 53 percent.
While all that sounds convincing, skeptics note that nine out of 10 women in the study underwent surgery to remove tumors that weren't cancer. Indeed, women who get the test should know that benign ovarian cysts commonly occur in women of all ages.
Expanded cholesterol testing
Cost: $75-$175
What's involved: Blood tests -- your basic poke with a needle. They break down good and bad cholesterol into subclasses that can give a better indication of heart-disease risk.
Half the people who have heart attacks have normal cholesterol under traditional testing. Part of the problem is that the typical cholesterol test doesn't directly measure your LDL, or bad cholesterol. It just measures HDL (good cholesterol) and triglycerides, and then uses a formula to come up with an LDL score. But the formula can be unreliable, especially if your triglyceride count is high.
Expanded tests not only provide a direct measurement of LDL, but they also look at the size, type and sometimes number of LDL and HDL particles. A person with a low LDL score could actually have a lot of small LDL particles, putting him or her at higher risk for heart disease. And a person with very high HDL, thought to offer dramatic protection against heart disease, might not be getting as much protection as he thinks, because he can have too much of the wrong kind of HDL.
Insurance plans often will pay for the test if a person has known heart problems or other risk factors such as diabetes. But they usually won't pay for the tests in healthy people -- even though it's estimated that 40 million otherwise healthy people have hidden heart disease. Studies show the expanded tests could have detected 95 percent of heart-attack patients early.
The best-known expanded test is from Berkeley HeartLab, a Burlingame, Calif., firm. Another test made by Atherotech of Birmingham, Ala., is known as the VAP test (for vertical auto profile), and uses a high-speed centrifuge process to study particle size. A third test, known as the NMR Lipoprofile (for nuclear magnetic resonance), uses soundwaves to measure the number of particles. It's made by LipoScience of Raleigh, N.C.
The Berkeley test has been used and studied longer. But the Berkeley test costs about $175, compared with $140 for the NMR and $75 to $85 for the VAP.
EBT heart scan
Cost: About $500
What's involved: A 10-minute scan in a doughnut-shaped machine. While you're lying down, the electron-beam tomography looks for calcium buildup that signals heart disease.
More preventive cardiologists are using the test because current risk-assessment methods miss as many as 75 percent of patients who go on to develop heart problems. As a result, for 150,000 people a year, the first symptom of heart disease is death.
The biggest-ever study of the scans, published last month in the journal Circulation, found that the tests are useful in predicting heart problems in intermediate-risk patients -- those without symptoms but with at least one traditional risk factor.
"EBT eliminates the guesswork," says Harvey Hecht, director of preventive cardiology at Beth Israel Medical Center in New York. "It tells you, 'These are your arteries. This is how much plaque you have.'"
Patients with high calcium scores may be prescribed medication or urged to make diet and lifestyle changes. In the case of heavy buildup, a follow-up stress test may be ordered to determine whether there is a blockage that needs to be treated.
But the test remains controversial. The presence of calcium buildup doesn't always increase your heart-attack risk -- it could be that the deposits found by the scan are stable and harmless. At the same time, a person who has a clear scan could actually have undetected and unstable plaque.
Spiral CT Scan
Cost: $200 to $450
What's involved: Glide feet-first into a scanner, stopping at the neck. The test can find lung cancer when it's as small as a grain of rice, compared with conventional X-rays, which often don't spot cancer until it's as big as an orange.
The overall five-year survival rate for lung cancer is just 15 percent, and studies generally show survival rates are longer with earlier detection. Still, not enough is known about whether patients are simply learning about fatal cancer earlier, or actually living longer. Thus, a debate is raging about whether early detection by spiral CT makes a difference.
While a major national study hopes to answer the question, the early evidence of the scan is promising. Right now, just 15 percent of lung cancers are found early. But in scanning studies, 80 percent of the cancers are caught in the early stages.
The biggest problem with the tests is false positives. A Mayo Clinic study found abnormalities on 51 percent of scans, but only 1 percent of the study group had cancer. That means half the patients had unnecessary and risky lung biopsies.
"Screening for lung cancer is not a benign and simple test," says Reginald Munden, section chief of thoracic imaging at the University of Texas M.D. Anderson Cancer Center in Houston. "If somebody wants to be screened, I'm not saying we should stop them, it's their money. But people need to know what they're getting into."
The Cornell group, with far more scanning experience, has pushed its false positive rate down to 15 percent. Patients can even request their scans be sent for review to Cornell, Mayo or Moffitt Cancer Center in Tampa, Fla. -- the centers with the most experience reading lung scans.
Aneurysm scan
Cost: $60-$200
What's involved: A five- to 10-minute ultrasound with a hand- held scanner pressed against the abdomen. The test can spot bulges in the artery wall long before they become life-threatening.
Aneurysm disease is surprisingly common -- it's estimated 7 percent of men over 60 have it. But few people have even heard of it or realize they might be at risk for abdominal aortic aneurysm, which kills an estimated 30,000 people annually.
Aneurysms caught early can be fixed with surgery. The surgery can be risky, and may require a lengthy recovery, but it nonetheless boosts survival to 96 percent to 99 percent. If an aneurysm ruptures, the chance of dying is 80 percent to 90 percent.
A quick screen ultrasound is ideal and costs just $60. But some centers may offer only a lengthier ultrasound that examines the entire abdomen and can cost $200.
(C) 2003 The Cincinnati Post. via ProQuest Information and Learning Company; All Rights Reserved
