New medical advances are reshaping the cancer diagnosis landscape with tests being marketed for their ability to spot signs of potential disease. These commercial screenings are promoted as ways to detect cancer early, which may increase the likelihood of positive treatment outcomes.
Unlike evidence-based, medically recommended screenings that are ordered by a doctor based on U.S. Preventive Services Taskforce guidance, commercial businesses offer their tests to anyone who wants and can afford them. No prescriptions are needed and there may be no particular reason to suspect cancer. These services are usually not covered by health insurance, including Medicare.
Among the testing being sold—separately or in packages—are full-body scans that search for tumors, genetic testing to see if cancer-linked DNA strands are present and blood tests that may reveal markers or cells related to cancer.
Many health professionals advise against commercial screening tests, saying they may not make sense for someone who doesn’t have symptoms or evidence-based risk factors for a cancer. While potential clients may see no harm in the testing, viewing it as a sensible precaution that may catch signs of an unsuspected cancer, experts say there are other issues to consider.
For instance:
Most are inconclusive. They can’t tell you if you have cancer or not. Instead, they look for abnormalities that may need further investigation.
False positives are common. The tests may produce “false positives,” leading to otherwise unnecessary medical procedures, or “false negatives,” showing an apparent clean bill of health despite cancer being present.
They may pose radiation risks. Some types of screening using full-body imaging may expose the body to radiation that may increase the chance of cancer emerging in the future.
The testing may be expensive. Tests not within current recommended screening guidelines typically aren’t covered by insurance.
But the concerns don’t seem to be dampening the public’s growing interest in commercial screening tests.
This article will examine:
- Evidenced-based screenings
- Cancer blood tests
- Full-body cancer scans
- Commercial genetic tests for cancer
- A growing interest in commercial cancer screening
- How to evaluate your cancer risk
If you’re experiencing cancer symptoms or if you’ve been diagnosed with cancer and would like to get a second opinion on your diagnosis or treatment options, call us or chat online with a member of our team.
Evidence-based screenings
Currently, the U.S. Centers for Disease Control and Prevention (CDC) recommend screening for early detection of breast cancer, cervical cancer and colorectal cancer and for lung cancer.
In general, the recommended guidelines are listed below.
Breast cancer: Women ages 40 through 74 should undergo a mammogram every other year.
Cervical cancer: HPV and/or Pap tests are advised for women based on age and previous test results.
Colorectal cancer: Colonoscopies are recommended for men and women ages 45 to 75, with follow-up procedures as recommended.
Lung cancer: Annual low dose computed tomography (LDCT) scans are advised for smokers ages 50 to 80 who smoke now or who quit within the previous 15 years.
These recommended screenings are typically ordered by a doctor and covered by insurance. Your doctor may recommend screening outside of these recommendations under certain circumstances, such as if you have a family history of cancer or are experiencing symptoms.
Many of the commercial screenings are not specific to a single cancer but are promoted as being able to detect a variety of cancers.
Cancer blood tests
Researchers have been working on blood tests that will be able to identify “cancer signals” for dozens of cancers, which may improve the chances of early detection.
The blood tests that have been developed are called multi-cancer early detection (MCED) tests. So far, none has been approved by the U.S. Food and Drug Administration (FDA). One such test, Galleri® , requires a doctor’s prescription, but is not FDA-cleared or approved. It falls under Clinical Laboratory Improvement Act (CLIA) regulations. Established in 1988, CLIA sets standards for tests performed on blood and other specimens collected from humans.
Galleri’s developers say it is able to identify sign for more than 50 types of cancer, and in some cases may indicate where in the body the potential cancer is located.
But even Galleri is not promoted as a test for just anyone. It is marketed to adults aged 50 and older, the population most prone to cancer. Though the hope is the blood test may detect cancers earlier, researchers still don’t know how far along a cancer has to be in order for signs of it to be detected by the blood test.
What concerns doctors about how blood tests are being used commercially to check for cancer?
“One is a false-positive screening test result that leads to invasive and expensive procedures to ultimately find no cancer is present. The second is the diagnosis of slow-growing cancers that may never cause symptoms, a phenomenon called overdiagnosis. And overdiagnosis, unfortunately, can sometimes lead to overtreatment,” says Philip Castle, Ph.D., M.P.H., the director of the National Cancer Institute (NCI) Division of Cancer Prevention, in an April 2022 article.
“There are also potential societal harms, including the unknown financial impact of widespread MCED test use before it’s known whether they reduce deaths from cancer,” Castle says.
Full-body cancer scan
Another form of testing promotes the use of full-body scans to screen for cancer. The testing may use computed tomography (CT) scans or magnetic resonance imaging (MRI). The scans look for signs of cancer throughout the whole body.
A drawback is that CT scans are a form of X-ray technology. The scans expose clients to radiation—though usually at low doses—that may lead to cancer.
The NCI says “whole-body CT has not been shown to be an effective screening method for healthy people. Most abnormal findings from this procedure do not indicate a serious health problem, but the tests that must be done to follow up and rule out a problem can be expensive, inconvenient, and uncomfortable. Also, they may expose the patient to extra risks, such as from an invasive procedure like a biopsy that may be needed to evaluate the findings.”
Commercial genetic tests for cancer
Some cancers have been linked to inherited genetic mutations, so genetic testing may help identify if those mutations are present.
But, according to the American Cancer Society, “most people (even people with cancer) do not need this type of genetic testing. It’s usually done when family history suggests that a cancer may be inherited or if cancer is diagnosed at an uncommonly young age.”
Home-based genetic tests don’t need to be ordered by a doctor. These direct-to-consumer options won’t tell you your overall risk for developing cancer, the ACS says, adding that they should not be used to replace cancer screenings or genetic counseling recommended by your doctor.
Eric Fowler, MS, LCGC, doesn’t recommend the commercially available genetic testing as a way to get hereditary cancer information, either.
“These direct-to-consumer genetic tests have the potential to provide information that is not accurate or medically actionable,” says Fowler, Manager of Clinical Genetics, at City of Hope® Cancer Center Chicago. “I recommend that people interested in genetic testing, to learn about risks for health issues or certain diseases, have a consultation with a medical provider and/or genetic counselor to discuss genetic testing options.”
A consultation may help determine if testing is indicated, based on the patient’s personal or family history, and how any results may impact medical management, Fowler says. In addition, the individual should also consider “the emotional impact of testing, testing cost, and privacy of the information,” he says.
A growing interest in commercial cancer screening
Retail screening services have become ubiquitous, with a boom of physical locations, solicitations in your mailbox and on television, with ads featuring testimonials from patients who claim these services saved their lives.
Boston-based market research firm BBC Research projects, “the global market for routine health screening is expected to grow from $59.7 billion in 2024 and is projected to reach $82.9 billion by the end of 2029.
“I think it's a rising tide that we can’t stop,” says Jason Budde, MD, Thoracic Surgeon at City of Hope® Cancer Center Atlanta. "Many patients express to me that they worry about their cancer risk, and after hearing from their doctors that they did not qualify for recommended screening, they paid for their own screening scans. These folks are informed and motivated consumers.”
In recent months, Dr. Budde has had two patients come to him after undergoing commercial testing—he calls it self-screening—that picked up signs of potential cancer. Both individuals turned out to have lung cancer that Dr. Budde was then able to treat with positive outcomes.
“There are several important points regarding self-screening,” Dr. Budde says. “First, remember that screening in general is how we detect disease early and save lives, particularly for lung cancer, which is a terrible killer. So it’s a powerful tool that should be used wisely.
“Second, lung cancer is trending up in nonsmokers, therefore screening guidelines may continue to change or expand in the coming years, as they did just this past year. So, today’s non-recommended screening may become tomorrow’s recommended screening.
“And finally, screening leads to necessary procedures if results are followed up in a responsible manner by expert physicians, such as at City of Hope Cancer Center. As for radiation risk, since these commercial consumers are generally undergoing low-dose scans once per year, the dose is negligible and no different from patients undergoing recommended screenings.”
Dr. Budde says he would encourage people thinking about commercial screening tests to talk with their doctor first.
“If they don't recommend it and you feel concerned enough, then you have the option to self-screen,” he says. “Obviously, they cost, but you know that up front.”
Dr. Budde admits some people find the idea of self-screening alluring, especially among those with a distrust of doctors.
“I think that there's a growing sentiment that you have to be proactive and screen yourself,” Dr. Budde says. “Well, we should definitely try to allay people's fears or paranoia because we don't want that. We want to be good doctors and nurses and we want to take good care of people. But, you know, it's hard. I don't know the answer as to how to get people to not be suspicious.”
Peter Baik, DO, FACOS, FACS, Thoracic Surgeon at City of Hope Chicago and Phoenix says he does not condone the use of commercial health screening because of the potential of false positives that may lead to unnecessary procedures.
“You know, if patients are willing to pay out of pocket, it’s their choice,” he says. “But they are being charged for something that has no proven benefit. A key part of an established screening program is the followup. It’s not just about getting screened the first time. It’s about following up with patients year after year to make sure they are adhering to the guidelines and are getting the proper screenings.”
How to evaluate your cancer risk
Trying to determine an individual’s risk for getting cancer is not a precise science. There are many factors to consider and different cancers with varying risk factors.
The most practical path is to follow medically recommended screening guidelines. Your doctor should also review your personal information to help you understand the factors you have that may increase or decrease your chances of getting cancer. City of Hope, for example, offers an online assessment for individuals to understand their cancer risk, the reasons behind that risk and ways to mitigate risk.
Some cancer risks you can’t do anything about, such as your gender, age, race and ethnic background, your family history of cancer and any history you have of risk-increasing activities, such as smoking or drinking.
But other risk factors are within your control. For instance, following recommended dietary guidelines may help reduce your risk of getting cancer, as well as exercise that improves your overall health. Quitting smoking and reducing or eliminating alcohol consumption are other ways to mitigate the risk of cancer.
Individuals shouldn’t take negative test results—whether from recommended screenings, or from unprescribed screenings from a commercial business—as a free pass to ignore cancer risk factors they have or to engage in risk-increasing behaviors.
If you’ve undergone a cancer screening and want to know what to make of the results, City of Hope doctors are available to assist you and they have years of experience diagnosing and treating cancer.
If you’re experiencing cancer symptoms or if you’ve been diagnosed with cancer and would like to get a second opinion on your diagnosis or treatment options, call us or chat online with a member of our team.
