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What to know about 6 popular home tests for allergies, cancer and more

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5 months ago

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What to know about 6 popular home tests for allergies, cancer and more

The 95-year-old patient was sure she had colon cancer. After noticing some rectal bleeding, she used an at-home colon cancer screening test. The results were positive. She feared her life was ending.

Her physician, Mark B. Pochapin, the director of the division of gastroenterology and hepatology at NYU Langone Medical Center in New York, examined her. “She did not have cancer,” he said. “She had hemorrhoids.”

Too often at-home medical tests produce false positives. Still these tests are appealing for their ease and convenience. Want to avoid a colonoscopy or check if you have thyroid disease or high blood sugar? From the comfort of home, you can swab, stick, poop and pee your way to important health information. But you may not be able to interpret the results or get reliable readings, physicians say.

Still, many Americans are using them, especially older Americans. The National Poll on Healthy Aging at the University of Michigan recently found that three in four adults age 50 to 80 believed at-home tests are more convenient than going to a physician or health-care provider.

Many people became comfortable with at-home testing during the pandemic as they tested for the coronavirus, said Matthew Weissman, professor of internal medicine and pediatrics at the Icahn School of Medicine at Mount Sinai in New York. But screening for other conditions is often more complicated.

“It’s great in the sense that it saves in office visits,” Weissman said. “Mostly, though, it still requires doctor intervention,” whether to prescribe medication or to help you interpret data.

At-home tests may be especially useful to the thousands of Americans who cannot get to a doctor, said Michael Hochman, an internal medicine physician in Long Beach, Calif.

Whether via telemedicine or not, at-home testing is most effective when you do it with your physician’s knowledge, Pochapin said. “You should tell your doctor, ‘I’m thinking of doing this test. Is it appropriate?’” he added.

But that may not be happening. According to Jeffrey T. Kullgren, physician and director of the National Poll on Healthy Aging at the University of Michigan, just 55 percent of those who bought and used an at-home test for infection shared the results with their primary care provider. “This suggests older adults are using these tests as substitutes for a doctor visit,” Kullgren said.

You can purchase most at-home tests online or at your local drugstore. Few are covered by insurance. We asked physicians about the efficacy of some commonly available tests:

1

Urinary Tract Infection:

Method: You urinate on a strip (or in a cup and dip a strip into the urine).

Cost: Around $11 (not covered by insurance).

What to know: “They basically test for things that are associated with UTIs like nitrates and leukocyte esterase, which are two things frequently seen with UTIs,” said Ivan Grunberger, director of urologic strategic initiatives at Lenox Hill Hospital in New York. But it is not the same thing as getting your urine cultured to determine which antibiotic will best fight your infection.

Whom it’s best for: “It’s not a bad thing for people who have frequent infections, who kind of know their symptoms, and have responded to antibiotics previously to test at home and then reach out to their physician.”

Method: Urinate on a test strip for five consecutive days, report your results to an app, which will collect other data from you. Log in to receive results.

Cost: About $20 (not covered by insurance).

What to know: Menopause tests promise to tell users if they are in perimenopause, a stage just before menopause. Manufacturers claim the product promotes communication between user and doctor, but most physicians say there is no relationship between urine hormone levels and symptoms.

Whom it’s best for: Many doctors say the tests aren’t useful for most women. “This single test will not diagnose you,” said Asima Ahmed, chief medical officer and co-founder of Carrot Fertility, a global fertility benefits platform. “It’s very important to look at all the factors and then review these results with a menopause specialist or someone who takes care of women in menopause.”

Method: Collect a stool sample. For the stool DNA test called Cologuard, which looks for DNA changes and small amounts of blood shed into the stool, you’ll need to send it to a lab. Results take about two weeks. A fecal immunochemical test (FIT), such as Second Generation, looks for hidden blood in the stool. It requires you to collect a stool sample and add a solution to it, and you have results in minutes.

Cost: A FIT test may cost anywhere from $30 to $120, and is sometimes covered by insurance. Cologuard’s $500 test is covered by most insurance, but must be prescribed by your physician and may require a co-pay or deductible. Some private insurance will cover both at-home tests, but if you have a positive result, your follow-up colonoscopy might not be covered since insurance considers at-home tests a screening procedure.

What to know: “When patients want to do these tests, I explain to them there’s a possibility this could be falsely positive,” Pochapin said, adding that the tests detect blood in the stool, which could be caused by conditions other than cancer. “So, if it turns positive, this does not mean you have cancer.”

Whom it’s best for: Pochapin added that the tests are meant for healthy individuals who show no symptoms. If you have rectal bleeding, do not use an at-home test; instead consult your physician immediately, he said.

Method: Prick your finger to collect blood and mail to a lab for results, which take about two weeks.

Cost: From $49 to $150. Some insurance plans will pay.

What to know: The accuracy of the tests may not be as reliable as those you’d get in your doctor’s office. And the results need to be interpreted properly. “A1C is a three-month average of blood sugar — and if someone is checking it, say every week or every month or every day and not realizing that those incremental changes are actually not something that you should be using to guide your management, it could be harmful or potentially fatal,” said Michael B. Natter, an endocrinologist at NYU Grossman School of Medicine.

Whom it’s best for: If you have diabetes, this can be a helpful tool for tracking your blood sugar, but you should not change your insulin or diabetes regimen without consulting a physician.

Method: Depending on the kit you purchase, you may go to a lab for a blood draw and then get electronic results through an app or you may prick your finger and collect blood that you send to a lab.

Cost: $50 to $500 depending on how many allergens you’re measuring for. Insurance typically does not pay.

What to know: “Allergy tests have high rates of false positive results,” said Eric M. Macy, fellow of the American Academy of Allergy, Asthma, and Immunology and allergist at Kaiser Permanente Southern California. “One would then waste time, effort, and money trying to avoid irrelevant allergens.”

Whom it’s best for: You could use the test for a specific allergen such as cat hair, Macy said. But, he added, “You could also figure out easily, and less expensively and more accurately, that you are allergic to cats by petting your cat and then rubbing your eyes or nose, because the cat allergen is on the fur and one of the sources is cat saliva.”

Method: Prick your finger to send blood to a lab for results in about a week. Most of these tests examine several biomarkers connected with thyroid disease.

Cost: From about $21 to $235. Not typically covered by insurance.

What to know: “I don’t know if I would trust it,” Natter said. “I think it’s a little premature. It does open the door a little bit to potential harm if patients feel emboldened to manage themselves and that could lead to more misuse of medications and miscare.”

Whom it’s best for: “If you really don’t know what your biochemical status is, in terms of your TSH or your free T4, then having that access to it at home could be beneficial,” said Natter. “But it needs to be in tandem with a healthcare provider to make the next management decisions based on that data.”

The FDA has created a list of reliable at-home medical tests, but doctors still advise caution. While home testing can be helpful and convenient, it’s important to remember a number of variables, including the lab that does the testing, can affect the quality of the results, said Donald Karcher, president of the College of American Pathologists and professor of pathology at George Washington University Medical Center.

It’s important to follow the instructions exactly as they are written, and to make sure you’ve collected the sample correctly, he said. “Not every at-home test is created equal,” Karcher said.

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