Top 5 overused screening tests April 4, 2023

As you know, I like saving you money on your healthcare. I despise wasting healthcare dollars on things that don’t help you or me determine if you have some covert deadly disease lurking in the background, until it’s too late. Screening for deadly diseases is a very tricky business. As a patient, your gut instinct might be to say, “Hey, the more information I have about my health,  the better, right?” The problem with this thinking is that you have to know what to do with this information once you have it. What if you have a positive result from a screening test? Now what to do? Do you go to a specialist and get further testing done? What about all the fear and worry that I have, that may end up being for no reason at all? 

We spend hundreds of millions of dollars in wasteful spending every year that accomplishes nothing more than a box to be checked, but don’t actually reduce disease and death. Where are our priorities? Part of this hesitation to make these changes involve “missing” out on the diagnosing that rare breast cancer, colon cancer, or heart disease. I get it. I don’t want to miss them either. But something has got to give and we need to start paying more attention to family history, and personal lifestyle choices. Just think about what we could do with a few hundred million dollars? How about teaching educational classes to minorities about the benefits of eating whole food, plant based diets? 

So I have compiled a list of the top five most overused screening tests, ranked by how much money wasted, generally speaking, on these tests. Geez, if only we could save all that money to put it toward more important things! That is my dream, anyway. So here it goes, my top 5 list of overused medical screening tests. Thanks to Washington State Health Alliance and Lown Institute for their efforts to educate us all. 

 

5. Screening colonoscopy beginning at age 45 without any family history of colon cancer and no risk factors for colon cancer. It’s difficult enough to justify lowering the colon cancer screening age from 50 to 45. But when you add to that the expense of a colonoscopy, it makes no sense at all. At the very least, those with low risk (healthy high plant, low meat based diet, non smoker, no first degree family history) should get a stool test, like FIT,  that costs around $20. A colonoscopy costs more than $2,000. 

 

4. Screening EKG without any history of heart disease or high blood pressure (23% overused/$40 million). The problem with an EKG (a quick test that uses leads that hook up to your chest)to screen for heart disease is that too many falsely positive readings are found. What if your EKG is “slightly abnormal”? Now what? Spend thousands on cardiology workup that proves, yet again, that you have nothing to worry about?  Screening EKGs are fraught with problems. We must be very careful, because this can turn very costly, very quickly. 

 

3. Screening vitamin D level without any previous history of vitamin D deficiency or osteoporosis (35% overused/$12 million). Vitamin D blood test screening is costly. Labs usually charge a lot more for these tests than other ones, which is probably why your insurance company will no longer pay for screening vitamin D tests. It turns out that supplementing vitamin D from a screening test doesn’t really do much. 

 

2. Yearly screening pap tests for women with no previous abnormal pap tests (73% overused/$19 million). If you are a woman, don’t get a pap test until you are at least 21 years old. If your first pap is normal, then you can wait 3 years to get the next one. If you are 30 years old or older, you can move the interval to 5 years if you also get HPV testing done with you pap (if it is negative).  If you are over age 65 and have had the last 3 pap results as normal, then you are done. If you have no cervix because of a hysterectomy, then you are done. The annual pap test for normal risk women is completely outdated. 

And finally number one (drum roll….)

1. Routine lab tests prior to  low risk surgery (85% overused/$86 million). This garnered the highest amount of overuse, at 83%. If you are planning on a relatively low risk surgery, like cataract surgery, colonoscopy, gallbladder surgery, tissue biopsy, or appendectomy and otherwise have no other medical problems, you don’t need lab tests like a blood count, electrolytes, or urine testing. While individual tests don’t cost a lot, they do add up over time. In the Washington example I provided, it amounted to over $86 million.