By Jill Ambrose, MBA, BSN, RN, partner and head of population health, and Daniel Keenan, vice president, business development executive
Cancer has long been thought of as a disease of aging, but that idea does not hold true today as early-onset cancer — defined as cancer prior to age 50 — is on the rise. According to a National Cancer Institute study published in Cancer Discovery, rates of 14 types of cancer, including breast, colorectal, kidney, uterine, stomach and pancreatic, have climbed in Americans under age 50 over the past decade.
The rise in early-onset cancer creates a growing risk for employers, indicating that a larger portion of their employee population may need cancer care at some point during their career. Additionally, employees managing a cancer diagnosis may face additional complications that can impact their productivity and presenteeism — from mental health challenges to making time for treatment.
While preventive screenings are crucial to catching cancer diagnoses early and in less advanced stages, these tools are not widely available to younger adults.
Research shows that certain cancers, including breast and colorectal, tend to be more aggressive and present at a more advanced stage in younger adults. In addition, cancers like testicular, cervical and ovarian can present unique challenges for younger adults who might be trying to grow their family. While some of these cancers have preventive screenings, they aren’t widely available or utilized by younger age groups for several reasons.
• Current guidelines recommend starting breast cancer screenings at age 40. Yet, the incidence of breast cancer in women under 45 has risen nearly 1% every year since 2001, according to the CDC.
• Regular cervical cancer screenings are recommended to begin after age 21, but about 25% of eligible patients are not up to date with screening, according to research from the National Cancer Institute.
• Colorectal cancer screenings are recommended to begin at age 45, but one in five new colorectal cancer cases occur in patients under the age of 55, according to the Cancer Research Institute.
Cancer care is already a primary concern for employers — with 88% ranking it among their top three health cost drivers. As cancer rates continue to rise in younger adults, employers must lead the charge in addressing this growing challenge and closing gaps in screening.
When cancer is diagnosed in earlier stages, treatment is generally less intensive and less costly for patients and employers. For early-onset cancer cases, catching diagnoses in early stages can be difficult as younger people are often not being screened unless they are experiencing symptoms or have certain risk factors like family history. Employers have an opportunity to help make screening a priority for younger employees.
For most people under 40, cancer risk is only top of mind if there is a family history. But research has shown family history is not the predominant factor in the rise in early-onset cancer. A Memorial Sloan Kettering Cancer Center study found that while those with early-onset cancer were more likely to have hereditary mutations, overall less than 20% of early-onset cancer patients had a genetic predisposition to cancer. Risk factors for early-onset cancer go beyond family history and may be linked to health habits like smoking and alcohol consumption; health conditions like obesity, diabetes and hypertension; exposure to food preservatives, etc.
Employers can:
• Encourage routine screenings and provide resources to help employees understand their benefits and make screening appointments
• Share information about signs and symptoms to look out for in common cancers like breast and colorectal
• Use cancer awareness months and days as opportunities to communicate with employees about the importance of screenings
• Provide education and other resources that promote healthy lifestyles that may reduce cancer risk
For cancers with early detection screenings — especially those rising in younger age groups, like breast, cervical and colorectal cancers, making screenings accessible to more employees is important. Diagnosis at earlier stages drives better employee outcomes and helps reduce high-cost claims.
Employers can:
• Lower or eliminate the screening age restrictions for common cancers with available screening tests, like breast or colorectal
• Consider offering lower-cost, noninvasive cancer screening options for employees who are younger than the recommended screening age. Some examples include options like Cologuard or Fecal Immunochemical Test (FIT) stool tests for colorectal cancer or self-collected HPV tests for cervical cancer
• Consider covering diagnostic screenings to limit the out-of-pocket cost for members when screenings become diagnostic
Costs and time off from work are common barriers to cancer screenings. In younger age groups, the perception that they are not at risk is another critical barrier causing them to delay screening. While getting an entire employee population to be compliant will always be a challenge, strategic incentives can make a difference. A study funded by the National Institutes of Health found that participants offered a financial incentive for colorectal cancer screening were more than twice as likely to complete a screening within two months.
Employers can:
• Consider offering paid wellness time for employees to use specifically for preventive screenings
• Offer flexible time to make it more convenient for employees to schedule screening appointments or encourage home screening options if flexible arrangements are not appropriate
• Identify the amount of time or the financial incentives needed to truly move the needle toward screening for your employee population and create incentive programs that stick
At Conner Strong & Buckelew, our risk management approach focuses on identifying cost drivers and leveraging innovative solutions to mitigate those risks. We understand that early cancer detection improves employee outcomes while driving down claim costs. In the midst of increasing rates of early-onset cancer, our employee benefits and population health experts can work with you to develop solutions tailored to your employee population.
Ready to reduce risk, contain costs and boost health results for your workforce? Contact us today to partner with experienced professionals who can make a difference.
Jill Ambrose, MBA, BSN, RN
Partner, Head of Population Health
Daniel Keenan
Vice President, Business Development Executive
