By Gary Gurian, program director of C-Change and William B. Baun, manager, Wellness Program - UT M.D. Anderson Cancer Center
Trailing only behind heart disease, cancer is the second leading cause of death in the United States. In addition to its tremendous human toll—more than half a million deaths in 2008 alone—cancer puts a huge financial strain on our health care system. According to the National Institutes of Health (NIH), the overall cost of cancer in 2007 was $219.2 billion—$47.6 billion more than it was just five years earlier.
Much of the burden of cancer falls to employers, who provide health insurance to more than 160 million Americans through their corporate health plans. Companies pay far more to insure employees with cancer compared with healthy employees, and additional dollars are lost as a result of missed work days.
Despite these mounting treatment costs, the fact remains that cancer deaths are often preventable. According to a recent report by the American Cancer Society (ACS), at least half of all new cancer cases can be prevented or detected earlier through screening. Three leading types of cancer, in particular—breast, colorectal, and cervical—can be prevented or detected early with relative ease. In addition, as documented by the landmark 2003, Institute of Medicine report, “Fulfilling the Potential of Cancer Prevention and Early Detection”, decreasing the prevalence of tobacco use and increasing the prevalence of good nutrition practices and physical activity can have a profound impact on reducing cancer morbidity and mortality.
Even as cutting-edge science continues to bring us newer, life-saving cancer therapies, the need for prevention and early screening is clear. Cancer prevention saves dollars and lives, and employers have a responsibility not only to protect their bottom lines but also to safeguard their employees’ health and well-being.
Cancer’s Impact on Business
Cancer—and the devastation it causes—is ubiquitous in the workplace. Among people ages 45 to 65, the largest segment of corporate employees, cancer is the leading cause of death. While people with cancer represent only 1.6% of the employee population, they generate around 10% of an employer’s annual medical claims.
According to the ACS, cancer is responsible for $128.1 billion in lost productivity annually. Cancer also is the second leading cause of long-term disability and the sixth leading cause of short-term disability claims in the U.S.
A study of major employers found that people with cancer cost five times as much to insure as people without cancer ($16,000 vs. $3,000 in annual costs). In fact, in 2006, the cost per member per month (pmpm) for health coverage of people without cancer was $360, whereas for people with cancer it was $2,390. This figure can be even higher depending on the type of cancer, with the pmpm for breast cancer at about $2,700, for cervical cancer about $3,500 and for lung cancer about $8,000.
Almost as startling as these figures themselves is how relatively feasible it is to turn them around. The cost savings that result from cancer prevention and early screening are significant and well-documented. Consider the following:
Breast Cancer
- A mammogram every one to two years can reduce the risk of death by about 16% for women ages 40 or older.
- Mammography every two years extends life for women ages 65 or older at a cost of about $36,924 per year of life saved. (Health economists generally agree that an intervention is cost effective if it can save one year of life for less than $50,000).
- Through early screenings, an employer could save $2,035 per year per employee in net patient care costs if breast cancer is diagnosed early rather than in an advanced stage of the disease.
Colorectal Cancer
- According to the U.S. Preventive Services Task Force (USPSTF), regular screening for colorectal cancer can reduce deaths by as much as 60 percent.
- An employer could save $896 per year per colorectal cancer patient in net patient time costs if colorectal cancer is screened and diagnosed during the early stage of the disease.
- Screening for colorectal cancer extends life at a cost of $11,890 to $29,725 per year of life saved.
Cervical Cancer
- Researchers have found that rates of cervical cancer death dropped by 20% to 60% after screening programs began.
- Pap screening every three years extends life at a cost of about $5,392 per year of life saved.
Cancer Related to Tobacco Use
Cigarette smokers, who make up 20% of the U.S. population, represent one of the most clear-cut examples of preventable health care costs to businesses:
- Employees who smoke have about two times more lost productivity per week than workers who have never smoked—an indirect cost of $27 billion to employers.
- Smokers, on average, miss 6.16 days of work a year due to sickness, including smoking-related acute and chronic conditions, while nonsmokers miss 3.86 days of work a year.
- According to a study by America’s Health Insurance Plans and the Kaiser Permanente Center for Health Research, investments in tobacco cessation can generate immediate cost benefits. By investing $.18 to $.79 per member per month, an employer can generate a cumulative savings of $1.70 to $2.20 per member per month after five years.
What Can Employers do?
Employers who are seeking to improve the health of their employees can start by mirroring what other companies are doing. For example, C-Change, an organization that brings together more than 150 nationally recognized leaders from the public, private, and not-for-profit sectors to reduce the burden of cancer in the U.S., has urged employers to reduce their companies’ cancer burdens through prevention and screening. The organization recommends the following steps:
Review your current health plan. Does it cover tobacco cessation services and breast, cervical, and colorectal cancer screening? If not, consider making these programs part of your coverage plan.
Eliminate co-payments and deductibles for cancer screening services. Studies show that more people opt to get these screenings if their out-of-pocket costs are reduced.
Extend coverage of these services to employees’ spouses and dependents. A company’s impact on cancer prevention can extend beyond employees alone. Spouses and children may also benefit from these services.
Inform employees of available services and encourage their use. Perhaps the most important step is making sure that employees take advantage of cancer screening and prevention programs. Suggested steps to encourage employee participation are:
- Include information about services in summary plan descriptions, benefits meetings, and health plan newsletters.
- Work with your health plan to send mailed or telephone reminders to workers when they are due for screening exams.
- Distribute fact sheets, pamphlets, and newsletters to educate employees about why and when they should be screened for breast, cervical, and colorectal cancers and about the availability of tobacco cessation services.
- Use payroll inserts, bulletin boards, e-mails, notices in mailboxes, announcements at meetings and shift changes, tent cards in break rooms, and gender-specific fliers in bathroom stalls to reach employers at multiple points.
- If possible, arrange for an employee to share a personal story of detecting cancer early and being treated successfully. If you don’t have an employee with a relevant story, contact the local chapter of the ACS to see if a local speaker is available.
- Invite on-site, mobile screening services (e.g., mammography vans) to come to your workplace. Check with your local ACS and local hospitals to see if these services are offered.
- Encourage employees to ask their doctors about receiving preventive services every time they go for a medical visit.
- Offer incentives, such as flex time, paid time off, or sick leave to make it easier for employees to make doctor appointments.
Collect feedback. Companies can determine how satisfactory these programs are by collecting employee feedback via surveys or e-mails. Future programs can be refined based on this feedback.
In addition to smoking cessation programs and screenings for breast, cervical, and colorectal cancer, there are a number of other steps companies can take to ease the burden of cancer among their employees. Programs that promote exercise and healthy eating, for example, can reduce the incidence of obesity, a known risk factor for cancer. A number of companies now offer healthier food options in their cafeterias, sponsor walks and races, and provide on-site fitness classes, all of which can help employees live healthier lives. In this context, C-Change also recommends that employers consider becoming a CEO Cancer Gold Standard-accredited employer.
In this context, C-Change also recommends that employers consider becoming a CEO Cancer Gold Standard accredited. This accreditation recognizes a growing number of large and small employers who have taken steps to improve the health of their employees and dependents through workplace policies and practices. These defined work place policies and practices are aimed at increasing the utilization of cancer early detection services, deceasing tobacco use and increasing good nutrition practices, physical activity and access to cancer clinical trials. To learn more about this innovative employee health promoting accreditation, please go the CEO Roundtable on Cancer web site at [web address]
A Healthier Future for the American Workforce
Today, the annual health care expenditure in the U.S. is $2.4 trillion—with more than $200 billion used for the treatment of cancer. With a challenging and evolving health care system at the heart of an uncertain economy, reigning in health care costs is everybody’s business. No matter what portion of coverage ultimately falls to the government and to individuals, significant responsibility will continue to lie with America’s employers.
A cure for cancer may be far in the future, but cancer prevention and early detection are within our reach. Preventive measures and screenings are proven to save lives while also providing a positive financial return on investment. In addition, these services can make a company more attractive to current and future employees, thereby aiding in recruitment and retention efforts.