Some docs like them, some docs hate them: The clinical tadeoffs behind DTC tests
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In my practice, I welcome these at-home tests as a conversation starter with patients. It allows me to ask why they were interested in this testing, what they were trying to figure out, and what their goals are.
—Kanwar Kelley, MD, JD
Love them or hate them, at-home health tests are becoming more popular.
MDLinx spoke with three physicians about which tests have merit, which are a waste of time, and how they might change practice.
“In recent years, there has been a rise in self-testing, and companies are jumping on this trend, promising a break on traditional laboratory test pricing and additional markers that ‘aren’t usually tested,’" Kanwar Kelley, MD, JD, a triple board-certified ENT-otolaryngologist and the co-founder and CEO of Side Health in Orinda, CA, tells MDLinx. "Most recently, I have been seeing patients who have been bringing in labs from companies like Function, Superpower, and others. Rarely—as the microbiome and gut health have become more popular—patients have brought in food allergy tests, microbiome testing, and other functional medicine tests."
“In my practice, I welcome these at-home tests as a conversation starter with patients. It allows me to ask why they were interested in this testing, what they were trying to figure out, and what their goals are. It provides a launchpad for deeper conversations about their health," Dr. Kelly continues. "However, the tests can vary in their usefulness. [They] may include several hundred markers, with many recommendations to sift through, leaving the physician or provider to process and triage all that information."
Popular tests among patients
John Ashcraft, DO, Chief of Colon and Rectal Surgery and Division Chief of Colorectal Surgery and Surgical Oncology at the University of Kansas Cancer Center, says he has seen patients at his practice use a variety of tests, including:
imaware, a finger-prick test for prostate cancer
Cologuard, an at-home stool sample for colon and rectal cancer
Shield, an FDA-approved blood test for colon cancer screening
Galleri and Cancerguard, blood tests for detecting multiple cancers among those aged 50 or older.
Dr. Ashcraft has mixed feelings about these tests, but admits: “These at-home tests allow for patients to take ownership of their own medical care. They also empower patients with knowledge about their risks and screening recommendations.”
He says that, at times, at-home tests make physicians' jobs easier: "If [the] testing is negative, then we can understand how to follow these patients." However, at other times, he stresses: "They can make our job harder, as there are no firm recommendations when the testing is positive for some of these tests (ie, with a positive Cancerguard, we can order imaging and ultrasounds) [but] otherwise, it can also be watchful waiting."
Empowering or predatory?
While at-home testing has the potential to empower patients, experts warn physicians to be on the lookout for tests that claim to help patients but may simply be trying to sell them unnecessary or unsafe products.
“I love to see more people invested in their health and taking actionable steps toward a healthier lifestyle, and I encourage my patients to come to me with any results they get from these at-home tests for us to go over together, Elisabeth Fowlie Mock, MD, a family physician and a director of the American Academy of Family Physicians’ board of directors, tells MDLinx.
“Depending on the test, the results may have introduced more questions than answers. These tests are not a substitute for in-person care and a strong relationship with your family doctor. Many [at-home tests] are predicated on selling the patient a proprietary product that may be unnecessary or, worse, contraindicated for them,” Dr. Mock says.
Related: Direct-to-consumer diagnostics: Disrupting care or creating more work for physicians?