Health screening question

[FinallyRetired]

So I get this offer in the mail from LifeLine Screening to do four health screenings on me for $129, saving $41. The four screenings are Stroke/Carotid Artery, Abdominal Aortic Aneurysm, Peripheral Arterial Disease, and Osteoporosis. I don't know why I got this, my doc hasn't referred me to anything and, if they had, the tests would be free. I did have a virtual colonoscopy a few months back and a CAT scan for possible stomach and kidney problems, turned out it was probably just a bad back acting up. Anyway, $129 seems cheap for these screenings but maybe not if they are unnecessary. Thoughts?

 

[Rich_by_the_Bay]

All screening tests must be considered in the context of what your risk is before being tested, among other things. Since all tests are imperfect, in a group with very low likelihood, a positive screening test result is more likely to be a false positive than a true positive. Such false positives result in additional worry, secondary testing (with cost, side-effects, etc.), and often more harm than good.

Also, the disease being tested for must be treatable early with better results than delaying treatment until symptoms appear. This is not always the case.

With that in mind, and assuming that one's risk is average for an unselected population....

Osteoporosis (bone densitometry): women, once at age 65 or so

Carotid Artery Ultrasound - does not appear to be warranted (more harm than good in the end)

Abdominal Aneurysm - male ever-smokers only (maybe), age 65.

Peripheral Arterial Disease - no benefit to screening

These are based on major scientific consensus panels which scour the world research on each test. Note that these and other tests may have a place in the evaluation of symptoms or suspected disease, just not in generic screening.

I suggest you use these guides to discuss with your own doctor whether such screening is right for you. These "total screening" outfits may have something other than your best interest in mind.

 

[FinallyRetired]

Wow, what an awesome board. I appreciate it, Rich, and will discuss with my doctor in light of your information. If I got this offer out of the blue, I suspect a lot of others may receive it as well. The thought did cross my mind about false positives and needless worry, but your information really narrows it down. Good reason to first go see your doc before acting on these offers out of the blue.

I do have one anectdote to offer, an unusual case of a random screening that saved a life for a different reason than intended. A few years ago Walter Reed was offering some kind of cardiac screening radiology to see if arteries are clogged, it was a new thing and they needed volunteers. So a family member goes in to get the screening. A week or so later he gets called. His arteries are fine, but they found a small growth in his lung which turned out to be cancerous (he had been a heavy smoker) but it was early and they took it out. So the heart screening saved his life for a different reason.

 

[Rich_by_the_Bay]

I do have one anectdote to offer...

Yes, the health care world is filled with anecdotes of lives accidentally saved by unnecessary tests and incidental findings. It is hard to convince people to play to the odds, not the high profile anecdote (I realize that you are not doing so, just some general observations).

What you don't see from those is the number of hidden-from-view cases which were harmed by that very strategy, for everyone that is helped. For example, if that unexpected lung lesion was operated on and happened to be an old scar from a harmless fungal infection, yet the patient died from complications of surgery. Or even if it was cancer and he died prematurely from complications.

Even the beloved PSA prostate tests leads to countless biopsies which are negative, but which cause infrequent blood stream infections and even rare deaths. Not saying not to do the test, just to consider all the factors before recommending it.

Glad you are thoughtful about it. Regardless of what you decide, at least you'll do so aware of the risks and benefits.

 

[cute fuzzy bunny]

I believe I've seen some studies that show that getting these screenings may be hazardous to your health.

Reasoning is somewhere between finding inconsequential things that you worry about, creating stress and actually trying to operate on the same iffy findings and doing harm in the process.

 

[FinallyRetired]

For example, if that unexpected lung lesion was operated on and happened to be an old scar from a harmless fungal infection,

Hey Rich, I have one of those anectdotes too, must mean I'm getting old. This was my neighbor at an AF base 30 some years ago. Healthy guy, 30s, non-smoker, fit, no problemo with his health. One day he goes in for his routine annual and they find a spot on his lung in an X ray. So they do major surgery, open his chest, and find what you said, a harmless fungal infection. Ooops... he didn't die but for the next couple of months he wished he had. A lot of pain and discomfort from having his chest cut open, long time off work, etc. I was always nervous about chest x rays after that. But I know they are necessary. I hope that today there would be alternative tests to differentiate lung cancer from some other bening conditions.

 

[Rich_by_the_Bay]

I was always nervous about chest x rays after that. But I know they are necessary..

Uh.. actually not. Screening chest x-rays for people without unusual circumstances is not recommended by any major scientific consensus panel, including the big prestigious ones. Sure is done alot, though.

Can't comment on your individual situation of course, but might be worth doing your homework and asking your doctor about it; after all it is a tiny bit more radiation exposure each time.

Yup, your anecdote is a good example of the downside of overzealous screening.

 

[calmloki]

...I do have one anectdote to offer, an unusual case of a random screening that saved a life for a different reason than intended. A few years ago Walter Reed was offering some kind of cardiac screening radiology to see if arteries are clogged, it was a new thing and they needed volunteers. So a family member goes in to get the screening. A week or so later he gets called. His arteries are fine, but they found a small growth in his lung which turned out to be cancerous (he had been a heavy smoker) but it was early and they took it out. So the heart screening saved his life for a different reason.

And to balance that anecdote, my Mom had screening done, but the screening did not look low enough. Tumor growing around her small intestine that was slowly closing it off. Surgery was not good, sectioned and sutured intestine segments did not seal, many icky details that resulted in her death about 3 months later, under my home care, from "malnutrition". The company that did the screening continued to harass us with offers to screen for her for years, even though i pointed out to them that she was dead and i was not interested.

 

[Webzter]

SoonToRetire... it'd be nice if they could test without being so invasive.

I went in to urgent care for a persistant cough and ended up getting x-rays. The radiologist noticed what looked like a patch on my lung. They brought me back for another x-ray and decided that it was definately worth checking out... talk about a scary few months.

Fortunately, a CT scan showed that the growth was on my back interior rib wall and not the lung itself. Because of its location and his experience, the surgeon told me to treat it as benign and follow up with CT scans every year. Due to where it's at, the only way to biopse is to go in through the front.. and so you don't biopse in that case because you'd need to go back in any way if it was something; you just take it all out at once.

Considering I now need to live, for a while at least, with ongoing CT scans and who knows what when I buy individual insurance, most days I wish I had never had that x-ray for my cough.

 

[FinanceGeek]

Rich_in_tampa you 'da man!

I have always wondered why people sign up to get these so-called "full body" CAT scans. You're exactly right - they are only of benefit IF you can detect a harmful condition that, if treated at discovery before symptoms begin, would really have benefited the patient.

Its always possible, but I've always felt that the odds are not favorable.

Thank you as a medical professional for explaining this in professional terms. Point, match, set!!!

 

[Zipper]

Rich_in_tampa you 'da man!

I have always wondered why people sign up to get these so-called "full body" CAT scans. You're exactly right - they are only of benefit IF you can detect a harmful condition that, if treated at discovery before symptoms begin, would really have benefited the patient.

Its always possible, but I've always felt that the odds are not favorable.

Thank you as a medical professional for explaining this in professional terms. Point, match, set!!!

.........and you dump on the Canadian System because somebody has to wait a couple of days for an MRI.

In my almost 64 years on the planet I've watched generations of Canadians get the timely care they need.

An MD will refer you in a heartbeat to a specialist, and if it's critical you're off to emergency from his/her office.

I would never trade my healthcare for the crapshoot you have down there.

 

[FinanceGeek]

According to some articles I've found its more than a couple of days...

"The median wait for an MRI across Canada was 10.3 weeks" as of 2006:
Fraser Institute - Canadians Waiting Longer for Medical Treatment in 2006 According to Annual Survey

"n a 2005 survey, half of the 2.1 million adults who had a non‑emergency MRI, CT or angiography in the past year reported waiting three weeks or less" (Ed note: this means that half did NOT get their scan done in three weeks or less)
Canadians begin waiting for surgery before getting on the wait list

Are these articles wrong or misleading in some way? I'm going off what a google search finds. Obviously if you live in Canada you should have more specific knowledge of the situation there, but how do you explain these articles?

FWIW, in the US there are many complaints about the healthcare system, but waiting lists for diagnostic procedures (even non-emergency, such as cancer followup, etc.) don't seem to be among the big ones I hear.

 

[cute fuzzy bunny]

Let me give you a pointer on surveys/studies.

The fraser institute mentioned in one of the above citations includes the following to describe themselves:

"The Fraser Institute philosophy combines an appreciation for the role of competitive markets, lower taxes, and less regulation, with a strong belief in the ability of individuals to arrange their own affairs."

When I read a survey/study I first examine the "about us" section to see what their agenda is, because thats whats going to color their results. People paying money for a survey/study almost always want a specific outcome and will seek out a firm thats good at producing that outcome.

This firms agenda seems pretty clear.

 

[FinanceGeek]

Well OK then, my other link with similar data came from the "Canadian Institute for Health Information". Are they also biased in some way? Who then would be an objective source of information to provide accurate data on waiting times for MRI in Canada? Do the provincial governments provide statistics we can see?

When I google terms like "mri wait canada" I get a ton of links reported back, virtually all of which strongly imply that there is some issue here...even some links from provincial government officials claiming to have reduced this problem or promising to tackle it. There are many many problems with the USA's system (such as it is), but wait times don't seem to be one of them. From looking at all of these hits on Canada's MRI wait times I'm left thinking "where there's smoke...there's gotta be fire...".

There was one link I found but refrained from publishing which actually claimed that there are more MRI scanners in Orange County, California than in all of Canada. That one was too hard for even me to believe so I didn't put it up, but its there if you search.

Again, back to what I said on the other thread - Canada's healthcare system definitely has a key advantage if it provides universal access to acute and routine care. That's clearly a "good thing" that our system doesn't provide except through a byzantine system of ER visits and failed collection attempts. Where it gets tougher for me to compare is when we talk about provision of expensive services like MRIs and CT scans, which as expensive as they are - seem far better than the "exploratory surgery" of days gone by. I just don't see how the economics of a single payer system can provide that kind of expensive care without significant rationing (in this case via wait times due to the lack of equipment and/or staff) over the long haul.

If there are any US or Canadian Doctors on this forum I think it would be great if y'all chimed in...since you're in the best position to add some professional perspective.

 

[cute fuzzy bunny]

I suppose I'd ask some people whose opinions I trust, who live in canada and use the system.

I would never dispute that someone in the US with enough money or the right insurance could have their buttocks removed and reattached to their earlobes by noon tomorrow, if they so chose.

I also sort of think that people in canada get the care they need in a timely manner. And that this doesnt stop people from whining that they had to wait.

I also believe there are more mri scanners in orange county than all of canada. Now you know why our health care costs a brazillion dollars.

 

[FinanceGeek]

I suppose I'd ask some people whose opinions I trust, who live in canada and use the system.

I would never dispute that someone in the US with enough money or the right insurance could have their buttocks removed and reattached to their earlobes by noon tomorrow, if they so chose.

I also sort of think that people in canada get the care they need in a timely manner. And that this doesnt stop people from whining that they had to wait.

I also believe there are more mri scanners in orange county than all of canada. Now you know why our health care costs a brazillion dollars.

The US system is clearly one of "where there's demand and money to fulfill that demand, there will be supply". And not all demand is wholesome or "money well spent". This by the way applies to virtually anything in capitalistic systems, including healthcare, illegal drugs, prostitution, you name it. Actually even the USSR (not a capitalistic system) had a decent trade in illegal drugs and prostitution, so its not just capitalistic systems, its human nature.

But is such choice so bad? Perhaps with illegal drugs and prostitutes, yes. But - who's job is it to decide what diagnostic procedures are necessary? I like to think it falls to the attending Doctor. Do Dr's in this country do "too many" diagnostic tests, in my experience the answer is firmly "yes". But when its my pancreas or my wife's thyroid that might have cancer or some disorder, honestly - I agree with my Doctor when he says "let's have a scan done, just in case". So far all negative, which is great. But someday maybe it won't be. Shall we wait then until we have significant symptomatic evidence of life threatening illness in order to do diagnostic tests? Perhaps. I said before I am NOT a fan of the elective full-body type scans, generate too much false positives. But, if I have the money and I want the test done, why not? For me personally I wouldn't do the full-body thing, there's a judgmental line somewhere, for me my Dr is the adviser of where that line lives.

Wasteful? Perhaps it is. Would I want to live somewhere that told me I can't have that level of care. No, I'd find other arrangements pretty fast.

As I said before what would be really helpful is to hear from some actual real-world Doctors on either side of the border...I highly doubt we can advance this discussion in any other way.

 

[cute fuzzy bunny]

I agree with what you're saying, for the most part.

The problems involve the insurance costs and increases, which are almost unbearable, and the lack of care for 20%+ of the population...with the burden of their end state care falling on us.

Also, i'm pretty sure in canada if you want a level of care that exceeds the standard, you're welcome to pay for it. Or get on a plane.

Otherwise, I'm not looking forward to the standoff that happens in a couple of years when the employers throw up their hands and stop paying for health care, the rich keep enjoying the benefits of our terrific system, and the other 85% of the population stands around waiting for the insurers to go bankrupt, the hospitals to realize that people cant afford to pay out of pocket, and the whole mess to implode.

 

[FinanceGeek]

Also, i'm pretty sure in canada if you want a level of care that exceeds the standard, you're welcome to pay for it. Or get on a plane.

Hate to bring this up, but to pay privately you'd probably need private health insurance no? But many of the URLs I'm finding on the Canadian healthcare system refer to ongoing debates on whether bans on private health insurance are constitutional or not...one article even talked about the supreme court of Canada striking down a ban on private insurance in Quebec.

So maybe now its allowed? I don't know, but again due to the nature of the links I'm seeing I'm thinking "if there's smoke...", e.g. there's some historical and/or current obstacle here with private pay.

Canadians can always go on a plane, or even drive South to the US, but then they'd have to pay American prices, WITHOUT American insurance. Has anybody ever noticed on your EOBs how the "negotiated" rate your insurance company pays is 1/4 to 1/2 the "rack rate" that you'd pay without insurance. I'm thinking that only very RICH Canadians could/would do that

As an aside I've often wondered why the major US health insurance companies don't sell "membership" in their preferred pricing club even to those who they won't underwrite or who cannot pay their premiums. That way at least the uninsured could get billed at a discount rate.