January 09, 2025

Exploring Innovation in Preventive Care

A fresh look at updated screening guidelines and evolving testing methods to assist employers in evaluating ways to improve their members’ screening compliance and reduce hidden cost barriers to accessing preventive care.

Full Series

The most common cancer screenings include breast, colorectal, cervical, prostate and lung tests. As a result of the development of more precise imaging and alternative screening modalities for breast and colorectal cancer, much progress has been made in the way malignant tumors are detected. However, adherence to testing recommendations remains a challenge, especially following the pandemic, when fewer patients pursued screenings for breast, cervical and colorectal cancer.¹

Employers can consider offering paid sick leave to reduce barriers to accessing screening services and encourage hourly employees to have the recommended cancer screenings. One study from the National Cancer Institute found that private sector workers in the U.S. who had access to paid sick leave demonstrated higher rates of cancer screening compared to workers without access to paid sick leave.²

Using Genetic and Biomarker Testing to Drive Early Detection

Genetic tests aimed at identifying gene mutations that indicate a higher risk of developing cancers or chronic diseases are rapidly evolving and becoming more accessible. In 2022, the genetic testing market size was valued at more than $7 billion globally and is estimated to grow at a compound annual growth rate of 22.0% from 2023 to 2030.³

As with other screenings, the cost and potential for unnecessary follow-up services should be considered in the context of the potential benefits of covering genetic tests. Patients who have a confirmed genetic mutation and/or family history can, as advised by a genetic counselor, alter the frequency of targeted screening or in more severe risk cases choose organ removal to prevent cancer from developing. For example, patients with BRCA1 or BRCA2 genes can choose to begin having mammograms done earlier in life and more frequently to increase the likelihood of early detection. The USPSTF recommends that plans cover genetic counseling and evaluation for BRCA1 and BRCA2 for women who have family members with breast, ovarian, tubal or peritoneal cancer.⁴

Biomarker testing is another tool to drive early detection and treatment. Biomarker tests are laboratory tests that examine a sample of tissue, blood or other bodily fluid for certain genes, proteins or other substances that could indicate the presence of a condition or illness. These tests can also complement treatment protocols to help clinicians determine how well treatment is working or predict the likelihood that a disease will recur.⁵ Multi-cancer early detection blood tests have risen in prevalence, and one Business Group on Health survey found that 10% of surveyed employers will cover these tests in 2025. In 2021, the health care company GRAIL rolled out the Galleri test, a multi-cancer early-detection blood test that can detect 50 types of cancer. One study found that Galleri has a false positive rate of 0.5% and is capable of detecting multiple types of cancer before the onset of symptoms. Though this test is not FDA-approved, it is available under a Clinical Laboratory Improvement Amendments (CLIA) waiver.⁶ Overall, genetic and biomarker tests have become powerful tools to help employers identify employees who are at higher risk for certain diseases, tailor treatment to patients and allow for early intervention and treatment.

Breast Cancer

Beginning at age 40, the USPSTF recommends that women of average risk receive biennial mammograms until 74 years of age.⁷ Conversely, the American Cancer Society recommends that women aged 45 to 54 receive mammograms every year.⁸ While screening mammography can lead to early detection of breast cancer, the risk of false positive results and unnecessary biopsies increases with the frequency of screenings performed. Diagnostic mammograms or sonograms (i.e., ultrasounds) are conducted when additional images are needed after the standard screening or when either the patient or physician notices a lump or thickening of the breast tissue. Mammograms can also be considered routine chronic care when they are administered as a follow-up procedure to tissue removal.

More than half of all women age 40 and older who get mammograms are found to have dense breasts.⁹ Breast density is often inherited but can be associated with other factors such as age, having children and taking certain drugs indicated for treating early-stage breast cancer.10 While the NIH’s National Cancer Institute (NCI) highlights how dense breast tissue can make mammograms harder to read and therefore more difficult to depend on as a screening tool, NCI also notes that these individuals are no more likely to die from breast cancer than those with breasts of average density.¹⁰ In March 2023, the FDA made updates to mammography regulations.^11,12 These updates strengthen the FDA's enforcement capabilities requiring that mammography facilities inform patients about the density of their breasts and assist physicians reading the images become better at classifying and evaluating mammograms.¹¹ These updates are intended to make sure that crucial information that can influence patients’ decisions, such as the need for more testing or a repeat mammogram, is well understood and explained.

Colorectal Cancer

Colorectal cancer screenings are categorized either as visual tests (colonoscopies) or stool-based tests:

Visual tests are invasive procedures that look inside the colon/rectum for abnormal areas that might be cancer or polyps.

Stool-based tests are non-invasive colorectal cancer screening options, as they do not require an office visit, anesthesia or bowel preparation. However, if the test indicates the presence of possible cancer or pre-cancer, a colonoscopy will be needed to confirm the result, possibly accompanied by the removal of any abnormal tissue or polyps.¹³ Stool-based tests should be completed every 1-3 years and between visual tests.1⁴

Although the risk of developing colorectal cancer increases with age, with more than 90% of cases occurring in people aged 50 or older, recent research shows that the incidence of colorectal cancer has been increasing by 1% to 3% annually for people younger than age 50 while decreasing in older individuals.¹⁵ Between 1995-2020, colorectal cancer incidence has risen from 11% to 20%, nearly doubling for Americans under 55.16 This meteoric rise now puts colorectal cancer as the leading cause of cancer death for Americans aged 20 to 49.¹⁷ Research also asserts that in the past decade there’s been a significant increase in early-onset colorectal cancer in the Asia Pacific (APAC) region.¹⁸

Lung Cancer

In the U.S., lung cancer is the third most common cancer in both men and women, as well as the leading cause of death compared to other cancers.¹⁹ The only recommended screening test for lung cancer is a low-dose CT scan for adults without symptoms who are between 50 and 80 years of age with a history of smoking.²⁰ Adults exhibiting symptoms that might be caused by lung cancer may need CT scans or other tests to find the underlying cause; however, such scans would be considered diagnostic services.²¹

Lung cancer screenings within the recommended populations are extremely underutilized. In a 2020 study performed by the CDC, just 12.5% of eligible adults who met the USPSTF criteria for lung cancer screening had a low-dose CT scan.²² While the lack of screening facilities in rural areas is likely a factor, as smoking and lung cancer mortality rates tend to be higher in these communities, patient and provider education on the importance of screening is key to ensuring that those who would benefit most are completing these tests. These challenges are mirrored outside the U.S. In fact, the European Union co-funds an ongoing public health initiative involving 15 member states, known as Strengthening the Screening of Lung Cancer in Europe (SOLACE) that aims to enhance equitable access to lung cancer screening in the region.²³

Cervical Cancer

Cervical cancer is detected in roughly 11,500 new individuals each year, and almost a third of those diagnosed will die of the condition.²⁴ The vast majority of cervical cancer diagnoses are caused by the human papillomavirus (HPV).²⁵ Specifically, two strains of the HPV, HPV 16 and HPV 18, account for about 70% of all cervical cancer cases in the U.S.²⁶ The primary barrier to diagnosis is that those infected with HPV have very few symptoms.

The USPSTF recommends that women aged 21 to 29 be screened for cervical cancer every 3 years using cervical cytology. For women aged 30 to 65 years, the USPSTF recommends screening every three years with cervical cytology alone, every 5 years with high-risk human papillomavirus (hrHPV) testing alone, or every 5 years with hrHPV testing in combination with cytology (co-testing).²⁷ As of December 2024, the USPSTF has drafted updated recommendations to explicitly include self-collected vaginal samples as part of a preferred HPV screening strategy.²⁸ Additionally, the ACIP recommends that children ages 9 to 12 be vaccinated for HPV.²⁹ Furthermore, cervical cancers are among the most curable form of cancer when diagnosed at an early stage; these patients have a survival rate of 92%. Those diagnosed at a later stage, however, have a survival rate of 59%.³⁰

Unfortunately, in the U.S. today, less than two-thirds of women aged 30 to 65 are up to date with their cervical screening, and women at the highest risk of being diagnosed with cervical cancer often lack access to the screening needed for diagnosis.³¹ One solution touted amid the pandemic was the nasal swab test for the cervix. A team at NCI found that 93% of women would be willing to perform self-screening at home, greatly improving the odds of cancer detection and prevention.³² There are varying levels of HPV screening and vaccination coverage among national public health systems around the world. For instance, Denmark, Australia, Sweden and the Netherlands use self-collection for cervical cancer screenings.²⁸ Moreover, Australia has been a leader in attaining high rates of HPV vaccination and created a fully funded national program to provide doses to boys and girls.³³

More Topics

Resource Plan Design & Administration Preventive Services Primary Care