Commentary Contributed by Arnon Chait, Ph.D., MBA, Cleveland Diagnostics
May 10, 2024 | Every resource in healthcare is precious. The last few years have tested healthcare systems in almost every way, with significant impacts on their long-term financial health and, by extension, the quality of care they can provide. A 2023 report by the American Hospital Association estimates that overall hospital expenses rose by 17.5% between 2019 and 2022.
Healthcare waste is one of many contributors to this complex equation. Studies assessing the cost of “waste” in United States healthcare spending estimate that waste accounts for 25 to 30% of annual spending. In an increasingly burdened healthcare ecosystem, it is crucial that we assess opportunities to reduce waste, particularly the waste that can directly impact the health and well-being of patients, such as overtreatment.
Overdiagnosis and Overtreatment in Cancer Patients
Cancer is scary in more ways than one. Not only are certain types of cancer increasing in frequency, but diagnosing and treating cancer are getting more expensive. Projections suggest cancer medical care costs in the US will exceed $246 billion by 2030. The economic and physical toll of cancer are considerable, and patients should be able to undergo treatment with confidence that the potential health benefits will offset the financial burden. However, it isn’t uncommon for cancer patients to be subjected to overdiagnosis and overtreatment.
Overdiagnosis and overtreatment are the detection and treatment of a disease that is unlikely to cause symptoms or death if left untreated, which is distinct from false positives, where patients are incorrectly diagnosed with cancer. In cases of overdiagnosis, patients might be subject to more mental and physical harm from the process of acquiring a diagnosis and the treatment than if the diagnosis wasn’t provided.
Overdiagnosis and overtreatment in cancer patients are often linked to unclear screening protocols and insufficient screening methods, such as tools that struggle to discern advanced cancer from low-grade (or early-stage) cancer or benign conditions. While diagnosing cancer early can be beneficial for some patients, other patients may experience more harm than benefit—for example, elderly patients who are diagnosed with asymptomatic, slowly progressing cancer. The overdiagnosis problem isn’t unique to one cancer cohort. One study estimates that 25% of breast cancers detected by mammography, 50% of lung cancers detected by chest radiography and/or sputum examination, and 60% of prostate cancers detected by prostate-specific antigen (PSA) are overdiagnosed.
Prostate Cancer: A Case Study in Overdiagnosis and Overtreatment
Prostate cancer serves as a case study for the toll of ineffective screening tools. Prostate cancer impacts 1 in 8 men in the United States and is particularly common in men over the age of 65. The journey to a prostate cancer diagnosis often begins with the PSA test, which measures the concentration of prostate-specific antigen in the blood. An elevated PSA can be a sign of prostate cancer or a sign of other prostate conditions. In other words, the PSA test is a prostate-specific indicator that something may be wrong, but it cannot accurately discern if the problem is cancer.
To address this issue, many patients with elevated PSA results are sent for follow-up testing, including prostate biopsies. The financial cost of this testing can be steep. Despite an estimated $1.86 billion spent each year on PSA testing and $2.5 billion on prostate biopsies, only about a quarter of men who have their prostate biopsied following an elevated PSA result are diagnosed with prostate cancer; the rest are false positives. Of those diagnosed with cancer, the number of patients overdiagnosed with slow-progressing or indolent cancers remains significant.
Ultimately, the U.S. Preventative Services Task Force (USPSTF) doesn’t recommend PSA-based prostate cancer screening for men over 70 because of the associated risk of overdiagnosis and the lack of data that screening increases survival rates. But, for men aged 55 to 69 years old, the USPSTF recommends providing screening to select patients based on individual risk factors and patient preferences.
Improved Diagnostics as a Potential Solution
Effective and efficient cancer diagnostic tools are part of the answer to reducing healthcare waste. By using diagnostic tools that are cancer-specific and discerning enough to provide information regarding a patient’s risk of high-grade cancer, we can potentially cut back on the number of patients who undergo a prolonged diagnostic process and unnecessary treatment. Unfortunately, however, many of the standard diagnostic options have problems similar to those of PSA testing. Genetic biomarker testing, for example, only indicates whether the individual has a genetic mutation that increases cancer risk, not whether the individual has cancer. Imaging can be a valuable tool in concert with another test but often provides vague results on its own.
Luckily, there is constant innovation in the space of cancer diagnostics. I believe a well of hope for the future of cancer detection lies in recent progress in screening methods that look beyond DNA and RNA—to altered proteins. Because altered proteins are a direct byproduct of cancerous cells, protein-focused screening gives a clearer picture of a direct manifestation of cancer. In the case of prostate cancer, higher specificity in detecting protein isoforms allows us to differentiate between normal PSA and PSA produced by cancerous cells. Tests focusing on identifying PSA isoforms have provided the same sensitivity as the traditional PSA tests but with improved cancer-specificity. A similar focus on improved protein detection and differentiation can also help diagnose other cancers with more accuracy. Tests like these can help clinicians triage at-risk patients to biopsy, cutting down the number of men who undergo unnecessary procedures.
Improved Diagnostics: Keeping Healthy Patients Healthy
Healthcare waste, particularly in cancer spending, impacts the entire healthcare system. It cannot be ignored, particularly as the number of patients seeking care continues to rise. Finding improved diagnostic solutions, such as those that go beyond the status quo, to address overdiagnosis and overtreatment of cancer serves as an opportunity to reduce waste and improve treatment for patients across the globe.
Dr. Arnon Chait is the Chief Executive Officer of Cleveland Diagnostics. An entrepreneur, scientist, and educator, Dr. Chait’s extensive multidisciplinary background spans physics, engineering, and bioscience. As CEO, he applies his vast experience commercializing innovative science to drive Cleveland Diagnostics’ vision of bringing early cancer detection into everyday practice with advanced testing that is more simple, accurate, and cost-effective than current options. He can be reached at Arnon.Chait@ClevelandDx.com.