It is said that those who do not know history are doomed to repeat it. In the spirit of this truism, a specter looming in underwriting is in dire need of sobering historical perspective.
Once upon a time, a cancer marker that showed initial promise was embraced for use in insurance screening by a prominent carrier.
Not for long.
The fallout was as diffuse as it was intense, coming from the media, the clinical community and consumer advocates.
At this writing, a modicum of momentum has been stirred for the use of another cancer marker. this one—dubbed CEA for carcinoembryonic antigen—is neither new nor untested. indeed, it has been used routinely for decades in meticulously specific contexts related to already-diagnosed colon carcinoma.
Unlike the other cancer marker in current use, prostate specific antigen (PSA), CEA is never used to screen for malignancy.
Might one fashion a case for using CEA in insurance screening? Absolutely, provided one is content to focus only on alleged protective value in a vacuum, akin to seeing the proverbial tree in lieu of the forest.
Such a case has now been carefully crafted.
Understand that arguments could be made for dozens of screening tests. Fact is, an airtight one, devoid of downstream consequences, exists for a cardiovascular test known as Nt-proBNp. Other candidates hover as well, awaiting due diligence.
If we can use Nt-proBNp, why not CEA as well?
Let us count the reasons:
CEA is not approved, and never will be, as a screening test. PSA is a sanctioned screening test. Nt-proBNP is all but assured the same destiny.
An abnormal Nt-proBNP test tells us there is likely some abnormality in cardiac function, most of which confer some excess mortality. This said, such conditions also will be manageable clinically, and interventions in at least some will enhance longevity prospects.
CEA, at the threshold advocated to demarcate a positive test, means that if cancer is present, the prognosis is likely far more ominous.
Isn’t this an argument for using CEA?
No. it’s a siren song.
The majority who are pinpointed by means of an abnormal CEA test will be told, after enormous personal angst and considerable (given health insurance these days) out-of-pocket expense, that they are cancer-free.
Such relief quickly turns to frustration, then to anger, egged on by the attending physician, who will say to this patient: “Frankly, I can’t understand why they would bring grief down upon your head by using this test in such an irresponsible manner.”
The only ears to which this damning statement plays as music decorate the heads of a well-described subspecies of attorneys.
Folks, this isn’t a hypothetical consequence of CEA screening.
It’s a certain one.
Decide now whether to proceed down this treacherous path in the certain knowledge there are other, smarter, safer alternatives for screening.
Apprehend history or reanimate nightmares.
Best's Review September 2008