Best to do preventative cancer screenings in Switzerland or USA?

Family, Education, Health and Pets
1
Hello,

I live in Switzerland but I had to fly home to the USA recently, as we put my dear mother to rest. And it occurs to me, with my father dying of pancreatic cancer and now my mother getting breast cancer and ultimately dying of lung cancer, to look into getting cancer screenings, both genetic and preventative, for myself.

For example: preventative CT scan of the abdomen, chest, and pelvis; colonoscopy; genetic test for the inherited Lynch Syndrome (the presence of which indicates an increased risk of many cancers) and others.

My question to the forums is whether anyone has experience to say if the Swiss medical system is keen on such genetic tests and preventative cancer screenings, or whether they are regarded as non-standard or non-recommended procedures, where I might encounter difficulty getting such procedures performed and/or covered by insurance. If so, while I am still in the USA, where such screenings are more routine, it may make sense for me to look into getting these done here before I fly home.

2

I can’t answer your question but certain Kantons in Switzerland offer free breast and colon cancer screening.
The list is increasing year by year but notably it’s the low tax kantons which don’t offer any free screening.

Given the cost of treatment, it’s in a country’s interest to push preventative measures rather than palliative care.

List and info here.

Cancer is just terrible. I’m sorry to hear of your loss of your mother.

3
I dont see anyone stopping you from getting these tests.

The main question would be whether your insurance would cover these charges. And that can only be answered basis your policy and/or confirming with your insurance provider.

4
I am very sorry to hear about your parents. My condolences.

I certainly understand your worries when there is a family history.

This comes with a heaping spoonful o' YMMV, but here is my experience:

Some screenings are allowed under the KK, with age and frequency restrictions. Gynecologists are generally good about preventative screening. For other cancers, talk to your GP, but be prepared for push-back.

Some GPs are more oriented towards prevention than others. My experience has been that outside of gynecology preventative screening has not been considered as important here. One GP frankly said it was a matter of cost reduction - which seems wholly counter-intuitive to me, but there ya go...

The GPs I have seen here also do not seem put as much importance in family history as a risk factor.

Even with clear symptoms and family history, I had to go back to the US to get diagnosed. That hurt the pocketbook, to be sure.

I seem to remember another thread where someone suggested going to France for typical cancer screenings, as attitudes tend to be different than in Switzerland, and costs certainly lower than the US... but I can't seem to find that thread now. Maybe someone will chime in with that info.

If you do go elsewhere, and if doG forbid there is a problem found, ask the doctor there if he or she would write a referral letter that you can send yourself to an oncologist here, just in case your GP is still reluctant to refer you for treatment. And of course bring all your test results, including scans, back with you.

If your GP agrees that a specific screening is warranted in your case, you might mention that you are willing to pay out of pocket if necessary. GPs are under pressure to reduce costs, so taking that issue out of the picture might make a difference.

I keep mentioning GPs, even though many tests are done by a specialist, because you often need a GP referral to see the specialist. This has nothing to do with insurance model. Even with traditional insurance that allows you to self schedule IME getting in to see a specialist without a GP referral has been nigh on impossible. Many require a GP referral in order to manage their patient load.

---

As above, YMMV. I'm sure other posters have had different experiences with their doctors here.

Wishing you all the best.

5
In BL, after 50, you can have a colonoscopy paid for by your insurance (so you still pay your excess/franchise/co-pay) every decade.

6
I am highly doubtful you would be able to have an elective CT scan or genetic testing done in CH in the public system.

I have had genetic screening done but it was not straightforward: I had been diagnosed with breast cancer and an aunt of mine has also had breast cancer and my grandmother had cervical cancer. So my oncologist at CHUV (the university hospital) referred me to a genetic specialist. I had to answer a detailed questionnaire and based on my diagnosis of cancer and family history the doctor recommended me for genetic screening.

The tests are super expensive (well into 4 figures) and aren't covered by basic insurance without their prior approval. The Dr. wrote to my health insurance stating their recommendation that I undergo genetic screening and asked for confirmation that my insurance would agree to cover the costs. It was only after I received approval from my insurance that I did the genetic screening. It was three appointments with the specialist in total at a few hundred francs a pop plus the test was something absurdly expensive. I want to say in the ballpark of 3000.- CHF, but I'm not sure of that.

Regarding the CT scan, the machines are already running at pretty much full capacity doing scans of people with actual diagnosis of illness or accidents. Radiologists are also already stretched to the limit with their workload. I think the system simply doesn't have enough resources to accommodate people who want elective (and very expensive) CT scans.

If you can afford to pay for such tests out-of-pocket I am sure you can get any test under the sun done in the US, and perhaps private hospitals in CH would be happy to charge you up the ying-ying, but within the public health care system I do not think it would be possible to have any of these tests or scans done without a clear medical justification.

7

Has anyone had a general gene analysis for health risks?
If so, was it useful?
Could you discuss the results with a doctor?
I recently had my DNA analysed for heritage - interesting results - if they are correct, there was a lot (more than the oft quoted 10%) of the biological father not being the father on the birth certificate. I am not convinced it is worth paying the same company to analyse for health risks.
The official Swiss attitude to such tests:
https://www.bag.admin.ch/bag/de/home…-gentests.html

8
Apart from certain cancers - breast being the obvious one, family genetics don't play as big a part as people like to think (and which statistics show).

Quite often, a family has a history of the same cancers simply because they live in the same environment, have the same lifestyle, eat the same types of food, smoke and so.

Then there's just that random possibility that they get the same cancer simply as a lot of people get that cancer.

My brother in the U.S. gets a lot of screening done on insurance - and likes to brag about it too.

However, his lifestyle choices are pretty appalling and they put in high-risk factor groups for many cancers.

I'd rather look after myself a bit (in moderation, whilst still enjoying the things that make life enjoyable) and (statistically) lower my chances of getting these cancers through self-responsibility.

Having said that, my sister lived an incredibly active outdoor life, and had a healthy lifestyle but was dead six weeks after being diagnosed so sometimes all you do is not enough.

9
This list is incomplete. In Zug, mammographies and smear tests are routine over a certain age as are the not very good blood tests for prostate cancer. Other tests are probably available and paid for by your insurance if you get a doctor's referral.

10

Here is a good site for cancer and genetics:

https://www.cancer.gov/about-cancer/…is%20increased .

11
The list is the two cancers which are tested at no cost to the patient - and without being credited to ones health insurance deductible.

You use the term "Paid for by your insurance". That normally means you for such a test as the cost won't be more than your deductible.

The whole point is preventative screening of two common cancers for everyone as many people just won't go if there is a financial burden to themselves.

Other cancers may not be on the list as there simply isn't a reliable test which justifies the cost. Your prostate test probably fits into that category.

If the list is not inclusive, it would be helpful if you could provide the links to other "free" tests as your answer was a bit vague.

12
I must admit I had not distinguished between those that are totally free and those whose costs (minus "Selbstbehalt") are covered by your insurance. Insurance will not reimburse you for any treatment until your deductible is used up. It is another reason to have the minimum franchise.

AFAIK, you cannot get an MRI or CT scan without a referral - whatever the reason for wanting it. Usually this is fore-coming if the medical evidence warrants it. It is not normal for routine screening.

One has to research to find out which cancer biomarkers are reliable and can be tested for - or consult an oncology expert.

13
If you go to your GP complaining of lung problems you're quite likely to get a CT scan. Similarly for colonoscopy and prostate checks or if you're already over 50.

I used to think about paying for full body scans but didn't and have somewhat regretted it.

14
I'm an oncology nurse in Geneva. Where are you located? With your family history, it makes sense to see a genetic counselor to determine if your risk is elevated and warrants a genetic test. If yes, the counselor will ask your insurance in advance if they approve reimbursement for the test. This is not usually a problem if deemed appropriate. If the genetic test results are positive for a pathogenic mutation, then you start the discussion about appropriate screenings.

15
I had genetic testing done in the US. Do you already know you have Lynch Syndrome? I don't know how it's done here, but given your history you could have it done here. Otherwise, my Stanford doctors recommended a company called Color Genomics. When I last looked it was $250 for genetic testing. I also recommend the organization called Facing our Risk (FORCE). Their website has a wealth of information for those of us with genetic mutations.

16
You have to be a US resident for that test. The OP lives in Switzerland.

17

This - regardless if the institute is public or private.

CT uses radiation which is correlated with an increase of cancer risk - however small - and therefore every exam must be individually justified. This is in the law and in every guideline, and candidates that are asymptomatic and without previous personal history are particularly excluded from this type of exams.
I don’t know the US law but I’m sure this applies to the US as well because it directly descends from the basic international guidelines of radiation protection.

MRI would be less of a problem, although it has its own exclusion criteria. EDIT: this company http://bodyvision.pro/ seem to be doing exactly what the OP wants, they say MRI & PET/CT here and there but the actual full body scan seems to be MRI only.

The main established screening is Mammography, that can and should be done even if some cantons don’t offer a screening program.
Why the difference with CT? There are a few ongoing studies but the benefits of CT screenings have not yet been robustly proven (not just in CH).

18
Thanks everyone for all of the information; and, the condolences -- it certainly has been a rough couple of weeks.

Thank you: I live in the Tösstal area, a little southeast of Winterthur, and so when I need to escape the ring of cowbells to take care of big city stuff, I typically go to Winterthur or Zürich. It makes most sense to follow established procedures, as you suggest, rather than try and carve my own path here. Does anyone know the German word for a genetic counselor? I have yet to make a visit to the primary care facility I selected with my insurance provider, Concordia -- a good thing I suppose, so this might make for a good maiden voyage. I would probably best be armed with a written history of every cut, scrape, and bruise ever suffered by every member of my immediate family, as my memory is garbage.

I am sorry to hear of this. That is an awful shock, and it's terrible to watch someone you love go out in that fashion. It has happened to me a few times now, and each time it brings what family I have left closer together; and, helps me realize and appreciate my own mortality and to have solace knowing that all the cancer screenings in the world might not keep you from getting hit by a truck, let alone spare you from getting some weird random ultra-rare cancer anyway. I also learned to appreciate that when the reaper calls, it's your time to high-five your buddies and graciously and fearlessly venture off into that unknown which, ironically, we all will know.

19

Genetischer berater. Online genetic counseling at CeGaT (Tuebingen):

https://cegat.com/de/diagnostik/

20

I was diagnosed with breast cancer in my mid 50s, and considered having a genetic test because my mother died of the same. My oncologist referred me to a geneticist. After discussing with the geneticist, I decided to not have genetic testing as I have no children, and I’m well monitored and the characteristics of my disease suggest that my yearly scans are the best preventive technique. I’ve also been no evidence of disease for almost 13 years. If the genetic counseling/testing would change my course of action I’d do it.

Lynch is pretty nasty stuff though and it’s worth a follow up. Genetic testing/counseling is covered by basic insurance as well as any required screening/scanning tests when you’ve been referred, usually by an oncologist.

For example, the Kantonal Spital in Winterthur has a genetic testing program associated with oncology.

https://www.ksw.ch/fachabteilungen/t…sche-beratung/

If your German is not great, my experience has been that most people speak some English as most research is written in English.

Probably you’ll need a discussion with your GP for an oncology referral. If you are female, your gyn can do the same. I’d say that if your GP is reluctant to provide a referral, then you might need a different GP.

I have had good experiences with my health care here, would be reluctant to go back to the us for care, but everyone is different.

You might also contact this researcher at the university of Basel who looks at hereditary cancers, including Lynch

https://dkf.unibas.ch/de/forschungsg…pe-katapodi-m/

Wishing you the best.