U.S. cancer screenings come with $43B annual price tag

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Initial cancer screenings cost $43 billion in the United States, according to a new analysis published in Annals of Internal Medicine.

Researchers used data from 2021 to estimate the yearly cost of screening patients for breast, cervical, colorectal, lung and prostate cancer. Private insurance covered an estimated 88.3% of costs, with Medicare covering 8.5% and Medicaid covering 3.2%.

Among the cancer types, screening for colorectal cancer made up 64% of the total cost, and screening colonoscopy represented an estimated 55% of the total, according to the study, “The Annual Cost of Cancer Screening in the United States.”

Medical costs of cancer

In anything, the total price tag is an underestimate, because it does not count subsequent testing, screening of ineligible patients, and overdiagnosis and overtreatment, said H. Gilbert Welch, MD, MPH, in an accompanying editorial, “Dollars and Sense: The Cost of Cancer Screening in the United States.”

As for colorectal cancer screening, colonoscopy is the dominant approach to screening, but it is labor-intensive for clinicians and patients, Welch said. It also is costly: $24 billion a year, compared with $600 million for noninvasive fecal immunochemical testing.

“Colonoscopy is clearly overused in the United States,” Welch said, and may be no more effective than stool testing. The study captures the costs of colorectal cancer screening, but does not account for abnormal findings that trigger additional testing for breast and prostate cancer, Welch said.

The study tallies screening costs for the population defined as eligible by the U.S. Preventive Services Task Force, but other data suggest men younger than age 55 and older than 70 are being screened for prostate cancer. Adults older than 75 years were screened for colorectal cancer, while women older than 74 were screened for breast cancer, and women older than age 65 were screened for cervical cancer, Welch said.

Meanwhile, overdiagnosis is rare in colorectal cancer, but overdiagnosis and overtreatment are most relevant to breast, prostate, thyroid and melanoma skin cancer screening, Welch said. Proponents “assert that cancer screening ‘saves lives’” and nothing bad happens to people who are screened with no finding of cancer, Welch said.

“Yet false alarms are common – followed by more appointments, more follow-up testing, and more procedures,” Welch said. “These require people to take more time off from work and pay more out-of-pocket costs. Some will experience complications. Then there are the few who are turned into patients and subjected to unneeded treatment.

“Exaggeration of benefits and minimization of harms cause real problems,” Welch said in the editorial.

New test for colon cancer

The study and editorial, with data on colorectal cancer screening, were published Aug. 6, eight days after the U.S. Food and Drug Administration (FDA) and Guardant Health Inc. announced approval of Guardant Health’s new Shield blood test for colorectal cancer screening. It is the first blood test to be approved by FDA as a primary screening option for colorectal cancer and the first to meet requirements for Medicare Coverage, according to Guardant Health.

Colorectal cancer, the second-leading cause of cancer-related death in the United States, is highly treatable if caught early. But more than 50 million eligible people don’t complete screenings “often due to the perception that other available options, such as colonoscopy or stool-based tests, are invasive, unpleasant or inconvenient,” said Guardant Health’s news release.

The company said the blood test would lead to “a new era of colorectal cancer screening.” The news release did not include exact prices or how the new test might fit within the larger context of the nation’s yearly cancer screening costs overall.