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Making smart screening decisions: Part 4: Commercial screening tests

Does screening for serious health conditions at your local gym or mall make sense?

While you were working out at the gym, walking through the mall, or visiting your church, you might have seen a sign for health screenings—an offer to quickly and easily test you for conditions such as heart disease, kidney disease, and osteoporosis. Companies like Life Line Screening and HealthFair offer these tests, but are they worth the cost? Dr. Celeste Robb-Nicholson, Harvard Women’s Health Watch editor in chief, explains why you need to be wary about commercial screening tests.

Is there any reason for women to have commercial screening tests?

I think the only merit to these tests is for the women who need them. The evidence is clear that screening for carotid artery disease and aortic abdominal aneurysm are only important in high-risk women. There’s no evidence to support testing for peripheral artery disease before you have symptoms. There’s also no evidence that screening every woman for chronic kidney disease is worth it.

Increasingly, the emphasis is on screening the right women, at the right time in their lives. These commercial screenings test for less common conditions, and should only be used in women who are at high risk for the conditions. Even for women who are at risk, sometimes there isn’t clear evidence that screenings have any real benefit.

How do commerical screening tests compare to tests done at a doctor’s office or hospital?

With the ultrasound tests, so much is dependent on the skill and expertise of the technician. Many of these mobile centers are accredited by organizations, but we don’t know how much oversight there is, and we don’t know how they compare to a hospital-based ultrasound. The results of a blood sugar test can be meaningless unless the test is standardized, and the only way to standardize a blood sugar test is to take it after a 12-hour fast. Doing a single creatinine test for chronic kidney disease isn’t really meaningful. You need to look at how the results change over time for it to be useful.

In most cases, getting these tests through a commercial screening company only means that you will have to go to your doctor to have the test repeated. Then you’ll have to pay for two tests. Your money would be better spent learning what your risk factors are (which may include some standardized testing), and then reducing those risks.

How much do commercial screening tests cost, and are
they covered by insurance?

The price is usually $150 to $350 for a package of tests, and it’s generally not covered by health insurance.

Are there any risks to having these tests performed by a commercial screening company?

There’s no physical risk from having these tests. Ultrasound tests such as abdominal aortic ultrasound and the heel test don’t give off radiation. The creatinine screening for chronic kidney disease is just a blood test. The only risk is that screening might lead to additional tests or invasive procedures. For example, if a screening test identifies an abnormality in the carotid artery or abdominal aorta, you might then need to have an angiogram—a test that does involve radiation exposure and other potential complications.

Are any tests worthwhile to have done by one of these companies?

I think blood pressure and cholesterol screening are a little bit different, because these are common problems and they’re silent conditions. The guideline is for most people to get a blood pressure check once a year, and a cholesterol check every five years if your levels are normal. It doesn’t matter where you’re tested. Once you know your blood pressure and cholesterol levels are high, you can see your doctor and get treatment. Getting your blood pressure and cholesterol tested at a local church is a simple thing to do. If it spurs a doctor’s visit that you would otherwise be procrastinating, that’s great.

Screening tests and recommendations

See your doctor to determine whether you need screening for these conditions.

Screening test

What it assesses

Recommendation

Carotid ultrasound

Carotid artery disease, stroke risk

No general screening needed for women without risk factors or symptoms.

Abdominal aortic ultrasound

Abdominal aortic aneurysm (ballooning of the blood vessel that supplies the lower body)

No routine screening for women without a first-degree relative with abdominal aortic aneurysm.

Ankle-brachial index

Peripheral artery disease

No routine screening for women without symptoms.

Heel ultrasound

Osteoporosis

All women 65 and over should be screened, typically with a DXA scan of the hip and lumbar spine.

Creatinine blood test

Chronic kidney disease

No evidence to support routine screening.

Posted by: Dr.Health

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