Years ago, I bought a whole-body CT scan and have used Life Line Screening where they perform ultrasound scans for aneurysm risk. Every year I get bloodwork that I dutifully carry to my doctor when I visit. In the past couple years, I’ve purchased comprehensive blood tests, urinalysis, cancer screening tests and tests for cancer markers. I bought tests for liver health, and kidney health. I’ve had a colonoscopy, an upper GI and both an abdominal and pelvic ultrasound. It was also past time for the colonoscopy, but I was also chasing down some symptoms that I wanted to ensure were not serious. In addition, I decided that in lieu of overpriced Obamacare I’d spend money on actual medical care that Obamacare would not have covered until I’d met a $10,000 deductible.
What was the value of all these tests? Almost nothing beyond peace of mind. Finding my cholesterol is mildly elevated did not prompt a change in my diet. Even the polyp removed during my colonoscopy would likely have never become cancerous. Only about 5% to 10% of polyps become cancer, but size and shape matter. Finding that I have the mildest form of reflux esophagitis did result in a prescription PPI, which I probably could have bought over the counter.
While I had some symptoms I wanted checked out, almost none of the tests improved my health. Indeed, researchers tell us that widespread diagnostic testing in asymptomatic people is a waste of money and often leads to unnecessary care. For instance, the whole-body CT scan from 15 years ago found a “spot on my liver that was statistically unlikely to be anything serious” according to the report. I took them at their word, but I could have easily gone to a doctor to chase down a benign cyst that was probably there from birth. A recent ultrasound confirmed it was still there and nothing to be concerned about.
Writing in Time, Dr. Matthew Davenport explains why more medical testing doesn’t always make us healthier:
Today, if you wish, you can go get a staggering amount of granular data about your health without your doctor’s involvement. All on your own, you can get an MRI of your entire body, a CT of your coronary calcium, an ultrasound of your blood vessels, and maybe someday an immersion ultrasound in a spa.
Direct-to-consumer medical imaging tests are a huge and growing business worth billions of dollars. Over 100,000 Americans are already customers. But do these test results actually make us healthier?
Dr. Davenport says too often the answer is no, medical testing does not lead to better health in many cases. Davenport explains:
In order to make a difference in someone’s health, the test must accurately predict or diagnose a condition, resulting in a change in mindset and behavior, and that change in mindset and behavior must produce a better outcome than not doing the test.
Davenport says it is not merely the test being performed. Efficacy is highly dependent on the patient being tested because some patients are at a higher risk than others. Some preventive screening tests are recommended by the U.S. Preventive Services Task Force, while others are not. Recommended screening tests are supported by evidence. For instance, mammograms are recommended every two years for average risk women beginning at age 40 through age 74. In 2009 and 2016 the Task Force recommended starting at age 50, believing earlier screening should be an individual choice, but had less evidence of benefit. That created controversy, since earlier screenings would not be covered by insurance. As a result of political pressure, in 2024 the Task Force updated recommendations to begin at age 40. What difference does the start date make? Breast cancer risk increases with age, but levels off around age 74. In simple terms, you must screen far more women to find breast cancer if screening between the age of 40 and 49. Thus, the cost per life year saved by screening women at age 40 (compared to age 50) is much more expensive.
The Task Force places a letter grade on preventive services depending on the evidence of benefit. Colonoscopy every 10 years in people age 50 to 75 has a significant benefit, earning a grade of A. Colonoscopy beginning at age 45 to 49 has less efficacy and earns a grade of B. Colonoscopy between age 76 and 85 only receives a grade of C. Yet, if a colonoscopy found a polyp greater than 10 millimeters a follow up screening is recommended in three years.
The harm isn’t just from wasting money on unnecessary tests. It’s also wasting money on additional testing to confirm or treat benign conditions the initial test identified. For some cancers you are more likely to die with them than from them.
Time: Why more medical testing doesn’t always make us healthier