Better cancer testing can help patients avoid unnecessary scans and biopsies, while also lowering costs for the healthcare system.
By Arnon Chait, PhD, MBA, chief executive officer, Cleveland Diagnostics
Americans are unfortunately well acquainted with the rising costs of healthcare in the United States. In 2023, patients, healthcare systems, and insurance companies spent a combined total of $4.9 trillion on health-related expenses. And with roughly 40% of Americans developing cancer at some point in their lifetime, it’s no surprise that cancer is one of the primary conditions driving this surge in healthcare costs. To relieve the financial burden on patients and the healthcare system caring for them, we need accessible solutions that both improve cancer outcomes and reduce costs.
It’s becoming clear that the way we currently screen for cancer can drive up costs for patients and the system. Advanced diagnostics have the potential to change that, simultaneously reducing spend while improving outcomes.
The Financial Burden of Cancer
As we grapple with the best ways to fight cancer, we must start thinking beyond pure biology. While finding effective treatments for patients is always important, we also need to address the significant financial burdens of cancer care. Out-of-pocket costs for cancer patients can reach upwards of $140,000, even for those who have insurance. These financial pressures make cancer patients 2.5 times more likely to declare bankruptcy compared to unaffected peers. These financial challenges can even affect health outcomes. As the Fred Hutchinson Cancer Center in Seattle has shown, bankruptcy is correlated with worse survival rates among cancer patients.
These costs burden the healthcare system as well. Within the United States, cancer-related healthcare costs are expected to reach nearly 222 billion dollars in 2025, and cancer-related claims account for 25% of all high-cost health insurance claims. As healthcare spending per patient goes up, insurance companies find themselves covering up to 73% of the total healthcare costs. All this data paints a clear picture of the enormous financial strain that cancer-related care places on our healthcare systems and the patients navigating it. Fortunately, it also reveals some clear insights into how this problem might be effectively addressed.
Tackling High Costs with Better Screening
Across multiple studies and multiple types of cancer, we see a consistent connection between the stage of cancer detection and the overall cost of care. Late-stage detection of cancer is invariably more expensive as treatment plans are more extensive and must occur with greater urgency. Furthermore, late-stage detection is associated with worse patient outcomes and extended treatment timelines that often require managing complications associated with prolonged cancer care. In comparison, early detection of cancer not only improves the health outcomes of patients, but it is also frequently less expensive to treat.
However, if not approached carefully, cancer screening itself can contribute to higher costs and patient distress. For example, if initial screening results are unclear, patients may be subjected to a series of follow-up tests or biopsies, which quickly multiplies medical bills and negatively impacts patient well-being.
Imprecise diagnostic tools can also result in overdiagnosis and overtreatment of cancer, meaning cancers are detected and treated even though they would be unlikely to cause symptoms if left untreated. Though overdiagnosis can occur at any age, this is particularly relevant for elderly populations, where overtreatment of a slowly progressing cancer results in worse quality of life.
Research suggests that overdiagnosis is also more common than we may think. One study found that positive screening tests only correlate with positive biopsy results in 25% of mammographically detected breast cancers, 50% of chest x-ray and/or sputum-detected lung cancers, and 60% of prostate-specific antigen-detected prostate cancers.
In short, we cannot simply increase cancer screening to address the rising costs of cancer care. We must also support clear, early diagnoses that will enable patients to avoid unnecessary procedures while receiving more targeted interventions. This requires in turn diagnostic tools that can reliably differentiate advanced cancers from early-stage cancers or benign conditions. Fortunately, the field of cancer diagnostics is rapidly innovating, leveraging a growing understanding of cancer biology to build more sophisticated tests.
Improved Prostate Cancer Screening
Prostate cancer serves as an excellent case study to examine how screening and diagnosis can be improved given that this disease is particularly prone to overdiagnosis. The initial screening process for prostate cancer begins with an examination of a patient’s prostate-specific antigen (PSA) levels. If PSA levels are elevated (4 ng/mL), physicians may order follow-up tests with a urologist, including MRI imaging or even prostate biopsies if tests continue to be inconclusive.
However, PSA levels can be high for a variety of reasons that have nothing to do with cancer: benign prostatic hyperplasia, prostate inflammation, or even recent exercise or sexual activity. This is why PSA testing, though useful for initial screening, is also a classic example of a diagnostic screening tool that is unable to distinguish between cancer and benign conditions, resulting in wasted resources and higher costs for patients and health care systems.
As our understanding of cancer biomarkers deepens, we are finding ways to overcome the limitations in screening tests that are not specific to cancer. Certain structurally modified variants of the PSA protein are known to directly correlate with cancer. By examining protein structure, glycosylation, and protein-protein interactions in addition to protein concentration, we can gain insights that are more accurate and clinically meaningful.
Conclusion
Bringing down the cost of cancer care will require inventive new approaches at every step of the patient journey. One of the most effective tools is simply determining if a patient needs care at all. Efforts to detect cancer earlier through increased screening must be paired with technologies that can accurately differentiate clinically relevant cases to avoid overtreatment and unnecessary spending.
About the author: Arnon Chait, PhD, MBA, is chief executive officer, Cleveland Diagnostics.
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