Joe Biden has cancer. His doctors diagnosed him with an aggressive form of Stage 4 prostate cancer that has already spread to his bones. Many experts are asking how could this happen? Until this past January Biden was the president of the United States. He had multiple doctors and access to the best medical care in the world. The test for prostate cancer – Prostate Specific Antigen (PSA) – is cheap and can be part of routine blood tests. At Walk-In Lab (my preferred online testing company) prostate cancer tests are $49 and $85 depending on the type of test. Annual wellness tests often include a PSA.
It has been about a decade since Joe Biden’s last screening for prostate cancer. That may sound like a medically negligent oversight, but it was not. President Biden’s doctors did not include a periodic prostate test because it is not the standard care recommended for men his age. This from The Wall Street Journal:
The 82-year-old Biden’s last known prostate-cancer blood-screening test was performed in 2014, a spokesperson for the former president said Tuesday. Prostate-cancer screening for men in their 80s isn’t considered standard care. The U.S. Preventive Services Task Force, a government-backed volunteer panel of experts that makes preventive-health recommendations, advises against PSA screening for men ages 70 and above, based on concerns about false positives and overtreating low-risk forms of the disease. Other groups advise older men to make the decision about whether to continue screening in consultation with their doctors.
“It’s in many ways unsettling that someone who has what is undoubtedly fantastic medical care could suddenly be diagnosed with aggressive, metastatic prostate cancer,” said Dr. Todd Morgan, co-director of the Weiser Center for Prostate Cancer at Michigan Medicine. “On the other hand, this is often how prostate cancer presents. We typically don’t do PSA screening beyond 75 or late 70s.”
The Affordable Care Act requires routine preventive screening tests recommended by the U.S. Preventive Services Task Force to be fully covered by insurance without cost-sharing. Joe Biden’s medical team was not constrained by what health insurance would cover. They were just following the recommendations. The purpose of recommendations is to advise doctors when tests are beneficial while being efficient. However, consumers should not consider the recommendations set in stone. In his book Priceless (Chapter 11), John Goodman wrote:
We could spend our entire gross domestic product on healthcare in useful ways. In fact, we could probably spend the entire GDP on diagnostic tests alone—without ever treating a real disease.
[M]edical science offers varying evidence on how frequent such [cancer diagnostic] exams should be, making this a subject of continuing controversy. That means that decisions about diagnostic tests often reflect a personal value judgment, and people’s values differ. In general, when a test is not prompted by a risky event or some other indication, it should be a matter of individual preference.
The age at which various screening tests are recommended (i.e., covered by health plans) is sometimes controversial. For instance, breast cancer screening is recommended for women beginning at age 45. Breast cancer advocates wanted breast cancer screening to begin at age 40. For most women, beginning breast cancer screening at age 40 is of no medical benefit compared to screening five years later. The cost per life year saved for earlier screenings is extremely high compared to later screenings because very few breast cancers are found by screening earlier. Prostate cancer is a slow growing cancer unless you get the rare, aggressive strain. Experts often say that men are more apt to die with prostate cancer than from prostate cancer. There is even some disagreement about whether doctors should treat most occurrences of prostate cancer in older men. That partly explains why Biden had not been screened in a decade.
Some screening tests are more invasive than others. Some are uncomfortable. Some are cheap, while some are costly. Risk tolerance also varies from one person to the next. Whether or not you have more testing than is recommended should be a choice not necessarily based on whether health insurance covers it. Numerous members of my family have died from cancer. Late last year I paid $350 for a screening test that looked for biomarkers for dozens of cancers. The test was not covered by insurance, but it was well worth the cost to know my probability of being cancer free over the next 12 months is 99.5%.
Read more at WSJ:
How Did Joe Biden’s Prostate Cancer Go Undetected?
Biden’s Prostate Cancer Diagnosis Reignites Debate Over When Men Should Screen