Early detection of disease is a benefit for both individuals and the society as a whole:
- Most diseases caught at an early stage are more easily treatable and even curable.
- The time required for treatment is less.
- The methods required for treatment of early stage disease are usually less invasive.
- The costs of treatment are much less.
To illustrate the cost of delayed detection, the average costs for treatment of breast cancer at each stage are
- Stage 0: $71,909
- Stage I/II: $97,066
- Stage III: $159,442
- Stage IV: $182,655 (1)
The gap between what insurance covers is $10,000 at Stage 0 and $50,000 at Stage IV.
The Federal initiative, Healthy People 2020, includes targets for screening for breast, cervical and colorectal cancer. Ideally, we would want screening to include 100% of those at risk for these diseases. In fact, the Federal goals are less ambitious, and are not being met:
- Mammography: target rate: 81.1%; actual rate: 71.5%
- Colorectal screening: target rate: 70.5%; actual rate 62.4%
- Cervical screening (Pap test): target rate: 93%; actual rate 83% and trending downward. (2)
While there are cultural differences in the rates of screening, the biggest single issue affecting screening is whether consumers have health insurance. For example, only 35.2% of women with no health insurance had mammograms. Only 25.1% of women with no health insurance had colorectal exams.
In the case of colorectal cancer, the percentages understate the problem. We have a rising incidence of this cancer among people in their 20s and 30s. However, there is no guidance suggesting that people in this age group have colorectal exams. So they’re excluded from the percentage calculations.
The other percentages are probably optimistic. People know they are supposed to have these exams, so some will respond to survey questions based on what they know they should have done, rather than what they actually did.
What you need to know:
- One way or another, you pay for healthcare for people who have no health insurance. The cost shows up in your hospital and doctor’s bill as well as in your taxes. As Milton Friedman famously said, there’s no such thing as a free lunch.
- Anyone’s failure to get regular screening drives up the cost for everyone. With health insurance, a Stage IV diagnosis drives up health insurance rates for everyone. Without it, as noted above, the cost shows up in hospital bills and taxes.
- The exception are those who commit suicide on receiving a Stage IV diagnosis prior to starting treatment. Is it time to legalize suicide?
The simple, ethical solution is to make sure everyone has health insurance and behaves responsibly with it.
- Helen Blumen, MD, MBA, Kathryn Fitch, RN, MEd, and Vincent Polkus, MSEM, MBA, “Comparison of Treatment Costs for Breast Cancer, by Tumor Stage and Type of Service,” Am Health Drug Benefits. 2016 Feb; 9(1): 23–32. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4822976/
- White A, Thompson TD, White MC, et al. Cancer Screening Test Use — United States, 2015. MMWR Morb Mortal Wkly Rep 2017;66:201–206. DOI: http://dx.doi.org/10.15585/mmwr.mm6608a1. https://www.cdc.gov/mmwr/volumes/66/wr/mm6608a1.htm?s_cid=mm6608a1_e