Cancer Tests Worth Paying For
|March 1, 2000
Nearly 1 in 30 Americans alive today has been diagnosed with cancer. For more than half of those, it's been 5 or more years since their diagnosis.
Pretty impressive, particularly when you consider that one or two generations ago, the odds of surviving cancer were slim. Improved treatment has helped - but so have earlier diagnosis and cancer screening.
"With screenings that can detect certain cancers early, we can significantly increase a person's chances of surviving those cancers," says Therese Bevers, MD, medical director of clinical cancer prevention at the University of Texas M.D. Anderson Cancer Center in Houston.
Regular cancer screenings can increase survival odds because they can
diagnose various forms of cancer when they're most treatable. Some tests
can even detect certain precancerous conditions, so they can be monitored
and treated before they ever progress to cancer.
Health insurance plans that cover preventive care often cover some, if not all, of the cost of screening tests. But even if your plan doesn't cover a particular test, it may be worth getting and paying for yourself.
Which tests should you consider shelling out for? That depends on your
circumstances - how old you are, whether certain forms of cancer run in
your family, whether you smoked during a profligate youth - and is
something to hash out with your physician, says Bevers. Here is a list of
less-frequently covered screening tests recommended by leading cancer
Genetic tests can detect mutations linked to two forms of colon cancer, familial polyposis and hereditary nonpolyposis colon cancer (HNPCC).
If one of your parents had familial polyposis, you should consider paying for genetic counseling and these one-time tests, says Harold Frucht, MD, director of gastroenterology at Fox Chase Cancer Center in Philadelphia. Ditto if you have three relatives with HNPCC-associated tumors. If you test positive for one of the mutations, you should have a colonoscopy - in which a physician uses a lighted flexible scope to check inside your colon - every 1 to 2 years.
The colonoscopy can detect precancerous changes in your colon, so that physicians can remove them before they become cancerous. Note: Unlike the genetic tests, the colonoscopy should be covered by your insurance.
Cost: $750 to $2,000
Endometrial biopsy and an alternative exam, transvaginal ultrasound, can help to detect endometrial cancer. But both are controversial because it's not yet clear if they can detect the cancer earlier than would be diagnosed if symptoms such as abnormal vaginal bleeding were present, explains Bevers.
Women at high risk for endometrial cancer - a group that includes women who have taken or are currently taking tamoxifen and women with an inherited form of colon cancer called hereditary nonpolyposis colon cancer - should discuss the pros and cons of endometrial biopsy or transvaginal ultrasound with their doctor, says Bevers.
Transvaginal ultrasound, combined with a blood test, the CA-125 test, may also help diagnose ovarian cancer. The CA-125 test measures levels of a proteinglyco- protein OC125produced by cancer cells. But this test is controversial too, in part because it can yield false- negative results, giving the all clear even when there's really an increased cancer risk, says Matthew Boente, MD, chief of gynecologic oncology at Fox Chase Cancer Center in Philadelphia.
To further muddle matters, the CA-125 test can also net false-positive results, particularly in premenopausal patients. That's why the best approach is to combine an ultrasound with CA-125 testing when checking for ovarian cancer.
Women with BRCA1 and BRCA2 mutations - genetic errors that have been linked to ovarian, breast, and some other cancers - should consider getting these tests twice yearly. If ovarian cancer runs in your family, you should consider getting them every 6 months, recommends Mary Daly, MD, PhD, director of family risk assessment programs at Fox Chase Cancer Center. At least one study has shown that regular testing may be promising for detecting early-stage ovarian cancer.
Cost: Roughly $250 for endometrial biopsy, and an additional $100 to
$200 for the pathologist's fee; about $200 for transvaginal ultrasound
alone; and roughly $250 to $500 for transvaginal ultrasound and
Insurance plans often cover annual mammograms for women 40 and older. But if two or more of your close relatives have had breast cancer - particularly if they were diagnosed before their 40th birthday - it's a good idea to start getting annual mammograms before you celebrate yours.
Your insurer may not cover early mammograms even if you have a family history of the disease. If that's the case, consider paying out-of-pocket.
Cost: $75 to $150
A professional version of the self-exam every woman should practice monthly, a clinical breast exam (CBE) helps physicians interpret your mammogram. The exam can also pick up tumors that don't show up in a mammogram, says Bevers.
"Most breast cancer authorities would say a CBE needs to be done as close to a mammogram as possible," she says. Some insurers such as Medicare, however, pay the tab for CBEs only once every 3 years in conjunction with a pelvic exam and Pap test. If yours is among them, it's probably worth covering the tab for an annual CBE yourself.
Cost: About $45 to $55 Keep in mind: Even if your insurance doesn't
cover annual CBEs, you may not always have to pay out-of-pocket. Though
some insurers won't cover an annual CBE for screening purposes, many will
cover the test if it's done for diagnostic purposes, e.g., to determine
the cause of breast pain, or some other disconcerting
In a genetic counseling session, a counselor analyzes your family's health history to determine whether you're likely to have inherited a genetic glitch such as the BRCA1 or BRCA2 mutation. If the answer is yes, the counselor will recommend genetic testing with a blood test. And if the tests are positive, she may recommend further tests, more frequent screening and preventive measures to increase your odds of beating cancer.
While many insurers cover genetic testing for mutations such as BRCA1 and BRCA2, they may not pay for counseling.
Cost: About $200
Lung cancer, which kills more Americans than any other kind of cancer, usually isn't diagnosed until it's too far gone to treat. That's because chest x-rays and other medical tests aren't sensitive enough to detect most lung tumors when they're small enough to be cured.
A recent study, however, suggests that annual low-dose CAT scans may do the trick, detecting tumors considerably earlier, when they're treatable.
More sensitive than x-rays, low-dose CAT scans could greatly improve the odds of surviving lung cancer, says the study's lead author, Claudia I. Henschke, MD, who heads the division of chest imaging at Weill Medical College of Cornell University in Manhattan.
If you're 60 or older and a smoker, or a former smoker, Dr. Henschke suggests that you consider getting a lung CAT scan annually, though the test usually isn't covered by insurance.
Initial scans tend to have high false-positive rates, turning up benign as well as cancerous tumors. Subsequent scans are more accurate because the radiologist is looking only for changes since the previous scan.
Cost: About $300 @PROSTATE CANCER
The prostate-specific antigen (PSA) test measures the levels of prostate-specific antigen, a substance produced by prostate cancer cells, in your blood.
The PSA should be paired with a digital rectal exam (DRE), in which a physician feels your prostate for irregularities that could signal cancer. Results from one test help a doctor interpret the results from the other.
Medicare and many private insurance plans that cover yearly physicals cover an annual PSA test and DRE for policyholders 50 and older. But that's probably not early enough if you run a higher-than-average risk of the disease - as you do if you're African-American or have a brother or father with the disease.
If you're at increased risk of prostate cancer, you should consider getting annual tests as young as 35, even if you have to pay the bill.
Cost: $50 to $60 for the PSA and DRE combined. Many hospitals and
health centers offer free prostate screening, particularly during the last
week of September, which is Prostate Cancer Awareness
A variation on the PSA test, the percent-free version, can help clarify your risk of the disease when standard PSA test results are borderline, Hanks says. The percent-free test measures the percentage of the antigen bound to protein in the blood and the percentage that is unbound or "free" and particularly troublesome.
The percent-free version may not be covered by your policy. "But if you're in that intermediate PSA group, especially if you have a family history of prostate cancer, you really should get the test," Hanks adds.
Cost: $15 to $75
During a total-body skin exam, a physician, usually a dermatologist, checks your birthday suit for suspicious moles and related growths and for changes in these growths since your last visit. These can be signs of precancer or cancer. Few insurers cover a total-body skin exam, but it's a worthwhile investment if you run a higher-than-average risk of skin cancer. People at highest risk - those who've already had the form of skin cancer called melanoma - should get screened several times a year.
If someone in your family has had melanoma, and you've got additional risk factors - you've spent more time in the sun than George Hamilton, have had lots of sunburns, have fair skin or many moles - make that twice a year.
If skin cancer runs in your family, but you've no other risk factors, a once-a-year check should do.
Cost: From $50 to $200 for a total-body skin exam; roughly $300 for
If you have chronic hepatitis B or C, which substantially raise your risk of cancer, your insurance usually covers a semiannual liver cancer screening test, called the alpha-fetal protein (AFP) test. Elevated AFP levels can be a warning sign of liver cancer. If the test shows elevated AFP levels, doctors follow it with an ultrasound for a better picture of what's happening down in the craggy depths of your liver.
Many physicians recommend doing the ultrasound every 2 to 3 months if AFP levels stay elevated. If you have chronic hepatitis B or C and your AFP levels remain elevated, you may want to get an ultrasound test every 2 months, even if you have to pay part of the cost.
Cost: About $425
If your health insurance plan doesn't cover a particular cancer screening test, you may still be able to get it without pulling out your checkbook.
Research centers studying experimental screening exams may offer them at no charge to volunteers who meet their study criteria, explains Mary Daly, MD, PhD, director of family risk assessment programs at Philadelphia's Fox Chase Cancer Center.