How much do they cost and what tests do you really need?
Posted Feb 01 2010 7:15pm
An article in today’s CBS Moneywatch.com reviews
diagnostics tests, their costs, purpose, concerns and if then test is worth getting. If
you are considering getting a non-emergency MRI, mammogram, CT scan, or nuclear scan,
be sure to read this article.If you want to learn more
about prices for these diagnostic tests, you can search the Outofpocket.com directory
to find true prices for these services.
Chalk it up as one more symptom of our broken health-care system: Americans waste
more than $250 billion per year on unnecessary
medical tests and treatments, according to a Thomson Reuters health-care analytics
report. Often, doctors order expensive, high-tech tests to rule out unlikely possibilities,
reassure worried patients, or as a CYA strategy against a possible lawsuit. An American
Journal of Preventive Medicinestudy found
that in 43 percent of cases where healthy people went in for routine checkups, doctors
ordered an X-ray, electrocardiogram, or urinalysis. So how can you be sure you’re
not wasting yourmoney on medical tests you don’t really need?
Unnecessary medical tests don’t just take money out of your pocket. They
can expose you to radiation, cause mental stress, and kill a day or more. Not to mention
their cumulative effect: ever-climbing
insurance premiums .
MoneyWatch wanted to find out whether five commonly prescribed tests are worth getting:
mammograms, CT scans, PSA prostate screening tests, nuclear heart scans and MRIs for
lower back pain. So we talked to experts in preventative and family medicine and pored
through the latest research about the risks and benefits of these tests, which can
cost up to $2,000 or more a pop. What we found may surprise you.
Of course decisions about medical care are intensely personal, and everyone’s circumstances
are slightly different. If there’s a key takeaway it’s this: Medical tests are not
analogous to checking your car’s tire pressure. Sure there may be benefits, but there
can also be negative consequences. Be sure to educate yourself on the downside.
Purpose: Non-invasive and painless, doctors use them to get detailed images
of everything from cancerous tumors to signs of heart disease to bone injuries. You
lie on an exam table that slides in and out of a machine. More than 70 million CT
scans are done annually; 23 times the number in 1980, according to the Radiological
Society of North America.
Cost: Varies widely; average price is $1,150 for a brain CT scan, $1,800 for
a chest CT scan and $2,175 for an abdominal CT Scan
Concerns: Researchers are increasingly fearful that the scans’ radiation could
lead to increased cancer risk and say that safer tests such as an ultrasound can sometimes
do the job. Then, there’s the danger of medical error. Last August, 206 patients at
Cedars-Sinai Medical Center in Los Angeles accidentally received eight times the normal
amount of radiation during their CT scans. “A single CT scan for an isolated problem
I’m not so concerned about. It’s when patients keep coming back for repeated exams
that cumulative radiation starts to add up,” says Dr. Aaron Sodickson, assistant professor
of radiology at Harvard Medical School.
Worth getting? If your doctor orders a non-emergency CT scan and you’ve already
had at least one previously, “ask your doctor if there are alternative tests that
can be done,” says Greg Morrison, chief operating officer of the American Society
of Radiologic Technologists. If you will undergo the test, first ensure that the facility
by the American College of Radiology and that technicians follow the ALARA (As
Low as Reasonably Achievable) protocol, so you’ll receive the lowest possible dose
PSA Prostate Cancer Test
Purpose: Doctors encourage men to get this simple blood lab test every year
to help them avoid the second leading cause of death among U.S. males. But the PSA,
or prostate specific antigen test, may do more harm than good.
Cost: About $45; up to $1,500 if the test leads to a biopsy
Concerns: The American Cancer Society does not support routine testing for
prostate cancer, because of the risk of over diagnosis and overtreatment. Studies
recently published in the New England Journal of Medicine found that PSA screening
does find more prostate cancer, but the early
detection does not translate into lives saved . For every man whose life is saved
by early detection of prostate cancer, 48 others will undergo unnecessary treatment
with possible side effects including impotence and incontinence.
Worth getting? Discuss your options with your doctor. Some men opt for regular
PSA screenings, but not to have surgery or radiation therapy unless an aggressive
cancer is detected.
Nuclear Heart Scan
Purpose: Doctors usually order these two- to four-hour tests after patients
have had unexplained chest pain or pain brought on by exercise. The scans are designed
to help detect narrowing of the arteries, damaged heart muscle, or to evaluate how
well your heart is pumping blood.After a radioactive ‘tracer’ is injected
into your veins, you take a stress test, walking on a treadmill or riding a stationary
bike at increasing speeds. Then photographs are taken, showing your heart after strenuous
Cost: About $2,000
Concerns: Although this type of imaging can be useful for diagnosing heart
disease, it’s overused. A pilot study of 3,035 scans for the American College of Cardiology
(funded by insurers and cardiology groups) found that about 18
percent of the nuclear heart scans were done unnecessarily ; another 16 percent
Worth getting? Ask your doctor whether an alternative test is available, such
as a stress echocardiogram ,
which does not involve exposure to radiation and costs about $1,000. Discuss the amount
of radiation you’ve been exposed to in the past to determine whether you may want
to avoid future radiation, when possible.
Purpose: A spinal magnetic resonance imaging (MRI) test can find changes in
the spine and other tissues, infections, herniated discs, and tumors without using
radiation. You typically lie on a moveable table that slides into a tube surrounded
by a magnet. Newer standing, or open, MRI machines are also available.
Cost: About $2,000
Concerns: MRIs can show every bump and lump, which may lead to procedures causing
more harm than good. The Health Affairs journal found that the increasing
availability of MRI is linked to an increase in surgery for lower back pain even
though symptoms for most back pain sufferers often resolve themselves without invasive
surgery. The researchers theorized that doctors ordering the MRIs have a tendency
to find something to blame in the resulting images.
Worth getting? Experts say that if you have lower back pain, wait at least
a month before submitting to an MRI. “The main reason you’d have an MRI of your lower
back is if you’re going to have surgery,” says Dr. Daniel Merenstein, Assistant Professor
and Director of Research in Family Medicine at Georgetown University Medical Center.
“But for routine low back pain, surgery has not been shown to be any better than Motrin
or other non-steroidal anti-inflammatory drugs or acupuncture.”
Purpose: The 10-minute X-ray procedure can be done for breast-cancer screening
purposes in the absence of symptoms or for diagnosis purposes after a doctor detects
a change in a woman’s breast.
Cost: About $125
Concerns: For years, women were advised to have routine screening mammograms
every year or two starting at age 40. Last fall, the U.S.
Preventative Services Task Force recommended less routine screening, concerned
that mammograms on women in their 40s yield a high number of false positives. For
women without risk factors, such as a history of breast cancer among close relatives,
the panel now recommends biennial screenings starting at 50 and until age 74.
Worth getting? Although the panel advises women in their 40s without significant
risk factors to discuss the usefulness of a mammogram with their doctors, leading
breast cancer experts, including American Cancer
Society and Susan G. Komen for the Cure , still
strongly recommend women get screening mammograms beginning in their 40s. “The American
Cancer Society acknowledges the limitations of mammography [but] overwhelmingly believe[s]
the benefits of screening women 40 to 49 outweigh its limitations,” Dr. Otis Brawley,
chief medical officer of the American Cancer Society said, in a statement. “We believe
the evidence does show there is survival benefit for women who get screening in their
40s, although we acknowledge that benefit is not great,” says Susan Brown, director
of health education for Susan G. Komen for the Cure. So until the medical community
reaches a consensus, it seems best to get the mammogram.