A cancer screening program in Arizona that offers the Galleri blood test to first responders provides some insights on how well the test can catch cancers in this high-risk group.
It would be welcome news to anyone, but especially to a firefighter, whose job brings a 9% greater risk of developing cancer and ain the previous 3 years. Both were more than a decade younger than Arenz.
But Galleri's ability to identify cancer and, perhaps more importantly, the fallout from wrong results, have been under scrutiny since the test's launch. Galleri, which has not yet been FDA-approved, is still so new that few know what incorrect results look like in practice and how often they might occur.After running the test on about 2,000 first responders, Shukla can offer some insights about the test's real-world value in a high-risk population.
The price of his peace of mind: an extensive work-up with a $4,000 price tag. Fortunately, the bill was covered by the screening program. In her experience, the binary test result – a simple positive or negative cancer signal – is an oversimplification of risk, she says. It"gives a false perception that you have cancer, or you don't," when the test itself is not definitive.
It's normal for a cancer screening test to prioritize specificity, says Aparna Parikh, MD, an oncologist at Massachusetts General Hospital Cancer Center in Boston. In a test like Galleri, which is meant to be used with other screening tests,"at least we are seeing a good specificity, which is important because we don't want false positives, where the downstream impact on the patient can be high.
Positive and negative predictive values, however, are more clinically relevant measures of a screening test. These numbers inform how likely a patient’s results are true, and therefore how worried they should be about a positive result and how much they should trust a negative . After a negative Galleri test, Arenz's cancer didn't slip through the cracks because he received other advanced imaging free of charge. But whether all doctors will go to such lengths to back up Galleri results, even in negative patients, is unknown.
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