PSA testing, life and health insurance, and full disclosure

Many readers of this blog quite certainly have strong opinions about the position of the American Cancer Society (ACS) on use of the PSA test in assessment of risk for prostate cancer. However, one does have to give credit where credit is due on a related matter.

On Dr. Len’s Cancer Blog today, Dr. Len Litchfield, the deputy chief medical officer of the ACS, discusses in some detail the anomaly by which, on the one hand, the U.S. Preventive Services Task Force (and the ACS) recommends against the routine use of PSA screening for risk of prostate cancer and yet, on the other, the U.S. insurance industry routinely requires PSA tests done on blood samples drawn from applicants for life insurance and health insurance programs.

According to Dr. Litchfield, this issue was raised in another physician’s blog a couple of days ago. However, your sitemaster has been commenting on the fact that insurance company’s have routinely required PSA data (without necessarily informing patients about this) for years, and an article on this subject appeared in the Journal of the National Cancer Institute (by Reynolds) as long ago as 2001.

The idea that having an elevated PSA level at a specific point in time should necessarily impact (perhaps considerably) the amount an individual has to pay for life or health insurance coverage seems at least weird and arguably bizarre. As far as we are aware, there are no data to suggest that an elevated PSA level is necessarily associated with an increased risk of death (from any cause). Furthermore, the knowledge that one is to receive a PSA test should most certainly be followed by acts on the part of the doctor and his or her patient to minimize risk that a PSA test will have potentially misleading results (e.g., the patient should be advised to avoid sexual intercourse or other comparable sexual activities for 24 to 48 hours prior to giving blood). Absent the awareness that one’s blood sample is going to be sent for a PSA test, how can any insurance company be making any type of accurate judgement about risk associated with an elevated PSA level?

For years the only reason your sitemaster ever got PSA tests done (because he considers himself to be at very low risk for prostate cancer) was when his insurance company did an annual blood test as part of his life insurance coverage. Your sitemaster found out that this was happening only because he asked very specifically what tests were being run on the blood sample provided each year. Luckily his results were consistently low and so there was no problem. However, …

The “New” Prostate Cancer InfoLink considers it to be unethical to give any patient a PSA test today without full disclosure up front. The same should be the case for a range of other much more useful tests (including, for example, the presence of HIV and other transmissable diseases). Health and life insurance companies should be held to the same standards of transparency as anyone else when they are playing around with an individual’s right to know what tests s/he is being given under specific circumstances, including things like drug screening as part of job applications.

7 Responses

  1. That’s it. I give up. Any such value is none of an insurance company’s business until I get a test as an act of my own free will. Suppose I were required to get a test each year and had to tell them that the value was 31 (it was). I predict that certain treatments will be withheld and that I’ll most likely die because of that. If this is one permissible aspect of Obama’s ACA, then it’s as fraudulant as I’ve constantly claimed it was. So would be Obama, for being complicit in this racket.

  2. Add long-term care insurance to the list that excludes anyone from coverage, no matter what the circumstances, if you may have “prostate cancer”. No opportunity to assess your risk of disease or death. It was an automatic “no”. Another reason we need new nomenclature for disease in situ.

  3. Dear George:

    This has nothing to do with the ACA. The insurance companies have been doing this for at least 15+ years to my certain knowledge!

  4. Dear Sitemaster,

    15+ years! I didn’t know that, having and needing no insurer now and between 1972 and January 2009 having insurers who never asked me a thing. But this was in Europe. Until the privatisation of Dutch healthcare on January 1, 2006, no insurer asked me a thing, and from then till 2009, thus after privatisation, ditto. I shall have to think about this. I dislike snap judgements about complex issues, especially issues I know little about.

  5. Dear George:

    Re: “having and needing no insurer now” …

    But you most certainly do have an insurer … It is the Swedish government … and you are paying a significant annual premium through your taxes for your health care benefits!

    Please don’t get me wrong. I am not criticizing. I am merely noting that in nations that have a nationalized, single-payer health system like Sweden, there is still an “insurer” who is guaranteeing certain levels of health care service. However, that insurer is not seeking to profit from the services it provides, which is at least something!

  6. Dear Sitemaster,

    Thanks for the correction. It shows how little I worry, or even think, about my sources of care and their finances. I hope this exchange will be read and thought about by many Americans, who live under a profit-making system. I moved to Europe in 1972, almost entirely because I experienced the single-payer NHS of 1971. I knew nothing about such systems, liked what I saw, learned quickly enough, and decided to move.

    One technical point. My healthcare payments do not come from my taxes. They are collected separately by the tax people and placed in an earmarked fund that covers everyone. The amount per month is independent of any past medical issues. I don’t know if the amount is significant, since I don’t know what it is (although I can come to know it). This is another example of how single-payer care can ease one’s mind.

  7. OK, here’s the thing … You can buy a home PSA test off the internet for ~US$US30 or so, to get your own data before you go insurance shopping … At least then you won’t be blind-sided.

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