Each year, nearly two million Americans are diagnosed with cancer, including breast, lung, and colorectal cancers.  This accounts for more than half of cancer deaths in the United States, annually. Recommended screenings, even in the absence of notable symptoms, can help in detecting these cancers early, increasing the likelihood of successful treatment and improved patient outcomes. Early diagnosis can also reduce the cost of employee health care and cancer treatment.

To mobilize effort and building on a strong focus of the Biden Cancer Moonshot on improving equitable access and utilization of cancer screening to save and extend the lives of countless Americans, the Cancer Moonshot announced actions from across the Cancer Cabinet and the private sector, as well as employers and labor unions, to expand access to cancer screenings, prevent more cancers before they start, and drive new innovation to deliver the latest progress to patients, families, and communities across America to improve health outcomes.

Increasing awareness
These latest actions close out the inaugural National Cancer Prevention and Early Detection Month, established as part of the Biden Cancer Moonshot, to increase awareness and utilization of critical cancer prevention, screening, and early detection to improve health outcomes for all Americans. In April, the Environmental Protection Agency (EPA) and Department of Veterans Affairs announced significant steps to address toxic and environmental exposures and prevent cancer and detect cancer early, when outcomes are best. [1]

In his proclamation of this inaugural month, President Joe Biden stated that: “It is important for every American to know that cancer screenings are lifesaving—early detection can make all the difference in beating the disease.” [2]

Impact of COVID-19
The impact of the coronavirus disease (COVID-19) pandemic on cancer screening has become a global concern.  During the pandemic, nearly 10 million screenings in the U.S. were missed, risking later stage detection of cancer, worse outcomes, and deepening inequities.  The President and First Lady made cancer screenings a priority for the Biden Cancer Moonshot – and delivered public and private sector actions such as those being announced today and since 2022.[3]

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In one study, researchers calculated rates of breast and prostate cancer screening and diagnostic procedures performed during the COVID-19 pandemic through December 2021 compared to the same months in 2019 in a large healthcare provider group in central Massachusetts. During the COVID-19 pandemic, the researchers observed a major decline in two common screening procedures, demonstrating the negative impact of the pandemic on cancer early detection and signaling potential downstream effects on the prognosis of delayed cancer diagnoses. [4]

For example, in this study, published in Cancer Causes & Control, the study’s authors noted that rates of screening mammography, tomosynthesis, and PSA testing reached the lowest levels in April–May 2020.

More detailed, breast cancer screening rates decreased 43% in March and 99% in April and May 2020, compared to 2019. And while breast cancer screening rates increased gradually in the beginning in June 2020 through 2021, this trend showed that this was considerably slower in Black and Hispanic women and in women aged 75–85.

Based on these outcomes, demonstrating a slower rate of return for breast cancer screening procedures in certain subgroups, the study authors called for vigilance-and responsiveness-to ensure that all women, regardless of age, race and ethnicity, return for routine screenings. [4]

In prostate cancer screening, the rates of prostate specific antigen (PSA) testing decreased by 34% in March, 78% in April, and 53% in May 2020. Testing rebounded to pre-pandemic levels by June 2020 with trends similar across groups defined by age and race/ethnicity.[4]

Overall, more recent reports now indicate that global cancer screenings are slowly returning to pre-pandemic levels. The number of participants, which decreased sharply immediately after the onset of the COVID-19 pandemic, only slightly recovered 2021. Therefore, the impact of this decline in participation in cancer-detection programs and changes in mortality need to be monitored carefully. [5]

The Biden Cancer Moonshot will continue to take actions to ensure all Americans benefit from the tools we have to prevent, detect, and diagnose cancer.

Today’s announcements from the Cancer Cabinet include:

  • The Department of Energy (DOE) will enhance lung cancer screening for workers exposed to lung carcinogens. Beginning this spring, DOE will expand its lung cancer screening program to include former Los Alamos National Laboratory and Sandia National Laboratories workers who were exposed to radiation, asbestos, beryllium, and other carcinogenic metals and toxins. Annual low dose CT scans for eligible workers will be provided at local radiology facilities in New Mexico through the DOE-supported Worker Health Protection Program and at selected other DOE sites across the country.
  • The Health Resources and Services Administration’s (HRSA) Accelerating Cancer Screening (AxCS) Initiative is investing an additional $10 million to support the Alcee L. Hastings Program for Advanced Cancer Screening, bringing the total program investment to over $25 million in three years. Through the AxCS Initiative, HRSA-supported community health centers are leveraging community outreach and engagement resources of the NCI-designated Cancer Centers to increase access and address barriers to cancer screening and referral for abnormal screening results. As a result of this partnership, the Patient-Centered Outcomes Research Institute has funded the University of Virginia Cancer Center to support health centers and community agencies with cancer screening follow-up and treatment.
  • The Centers for Medicare and Medicaid Services (CMS) are increasing cancer and tobacco-use screening awareness through new CMS Innovation Center (CMMI) models. CMS announced three CMMI models in the last year that include cancer screening and tobacco screening/cessation measures, including Making Care Primary (MCP), Innovations in Behavioral Health (IBH), and States Advancing All-Payer Health Equity Approaches and Development (AHEAD). These models actively promote breast cancer screening, colorectal screening, and tobacco use screening and cessation intervention through their performance measurement frameworks.
  • The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. is finalizing a new resource to address health equity and environmental justice related to cancer patterns. These resources, which will be posted online and downloadable as a PDF, will address important actions for communities to evaluate cancer incidence and death rates in environmental justice areas and resource information to help impacted communities. Tools such as CDC/ATSDR’s Environmental Justice Index, developed in collaboration with HHS’ Office of Environmental Justice, can be used to identify communities with the greatest cumulative environmental injustices.
  • The CDC’s Immunization Services Division has cooperative agreements with the American Cancer Society (ACS) to improve HPV vaccination rates and vaccine equity through education, quality improvement projects, and other collaborative activities. In coordination with health plans participating in their 2-year learning collaborative, ACS developed the ACS Health Plan Action Guide, due out in May 2024. The action guide will help health plans implement evidence-based interventions to improve HPV vaccination coverage among their enrolled adolescents.
  • The U.S. Fire Administration will step up on cancer screenings and PFAS-free bunker gear. The U.S. Fire Administration (USFA) is promoting better access to cancer screenings for all firefighters so cancer indicators can be discovered at the earliest possible exam. To protect firefighters from PFAS, the USFA and national fire service leaders are working with federal partners, standards-making organizations, and textile manufacturers to institute the next-generation PFAS-free bunker gear to mitigate this common exposure risk for the 1.2 million career and volunteer firefighters across the nation.
  • The Department of Veterans Affairs (VA) will explore radon gas exposure as a factor in lung cancer screening efforts for veterans.  Using county-level radon gas exposure data from the Center for Disease Control and Prevention (CDC), the VA will begin by assessing the correlation between regional radon hot spots and lung cancer incidence among veterans. Radon gas exposure information may ultimately enable health care providers to connect at-risk veterans with lung cancer screening services.
  • VA is expanding delivery of high-quality, coordinated cancer care closer to veterans’ homes. By end of fiscal year 2025, VA will expand cancer treatment at VA clinics to an additional 30 sites—serving an additional 9,000 veterans each year—and extending services to provide the full continuum of cancer care from prevention and screening through treatment and surveillance. VA launched this service as a pilot in 2021 and has treated nearly 500 veterans at 20 VA locations, saving veterans undergoing cancer treatment and their caregivers over 200,000 traveled miles.
  • The U.S. Department of Labor’s (DOL) Mine Safety and Health Administration published a final rule this month to better protect miners from health hazards associated with exposure to respirable crystalline silica, also known as silica dust. Inhalation of respirable crystalline silica puts miners at risk of developing serious and irreversible diseases, such as lung cancer, silicosis, progressive massive fibrosis, chronic bronchitis, and kidney disease. DOL’s final rule will require proper engineering and administrative protections that will reduce silica dust exposure, prevent lung cancer and other illnesses, and improve miners’ health.

In addition to these announcements, new commitments from nongovernmental organizations include

  • DELFI Diagnostics will partner with the Indigenous PACT Foundation and OSF HealthCare Cancer Institute to advance lung cancer screening that could save tens of thousands of lives. DELFI will offer a blood-based lung cancer screening test this spring that seeks to increase lung cancer screening rates among those eligible, and particularly in underserved populations. Work with the Indigenous PACT Foundation to enhance lung cancer screening rates will emphasize incorporating cultural practices and promoting inclusivity, beginning with Muckleshoot Indian Tribe and other Tribes in the Pacific Northwest, with a goal of expanding the program to other Tribal Nations.
  • Gabbi, offering virtual breast health care, will expand early detection services in a dozen states including Florida, Texas, Illinois, Ohio, Virginia, Georgia, New York, and New Jersey. Gabbi democratizes access to early detection via telehealth so every person can understand their risk and get the right care at the right time. With an emphasis on risk assessment, Gabbi aspires to reach people of all ages and ethnicities, ensuring breast cancer is found at the earliest, lifesaving stages.
  • ACS will lead a nationwide effort to increase prostate cancer screening access through an initiative aimed at improving shared decision-making to reduce health disparities. ACS’s initiative connects 12 participating community health centers and the more than 40,000 patients they serve with national experts to share best practices, determine if prostate-cancer screening is advisable, and enhance capacity to find prostate cancer early when treatment is more likely to be successful.
  • The University of Texas MD Anderson Cancer Center, ACS and Becton, Dickinson and Company (BD) are collaborating on an initiative to improve cervical cancer screening through self-collected HPV testing. Despite vaccination and screening, there is growing evidence that cervical cancer incidence is rising in medically underserved populations. The program will expedite self-collection adoption in underserved communities that are supported by safety net clinics.
  • Guardant Health will step up with actions to advance colorectal cancer awareness and screening in vulnerable communities. Guardant will partner with the First Ladies Health Initiative, a faith-based organization, in Chicago and other U.S. cities to understand perceptions impacting colorectal cancer screening utilization in minority communities and produce a report of the findings with educational materials to increase screening awareness.  Additionally, in partnership with Ballad Health in Tennessee, Guardant will investigate how blood-based colorectal cancer screening can be integrated into and complement current screening at primary care sites in Appalachia, with publication of study results to highlight key learnings on patient acceptability of, and utilization of, CRC screening.
  • The American Society for Gastrointestinal Endoscopy (ASGE) will advance critical projects to increase follow-up colonoscopy rates, which remain unacceptably low among uninsured and underinsured populations. The ASGE Colorectal Cancer (CRC) Screening Project will begin targeted stool-based CRC screening in Georgia and Maryland as early as May 2024, and those with an abnormal test result will receive a timely follow-up colonoscopy. ASGE will use data from these pilot projects to develop a model that other states can use to increase the follow-up colonoscopy rate for underserved patients by the end of 2026.
  • Teen Cancer America will launch new series to educate 25,000+ readers about advances in prevention and early detection. Teen Cancer America (TCA) is a nonprofit organization dedicated to empowering teens and young adults with cancer through information and resources. As part of its weekly publication, “Breaking Cancer News,” TCA will launch a special weekly series called ‘Prevent and Detect’ about the latest advances in prevention and early detection, so that more communities can advocate for health improvement, cancer screening, and best early treatment options to improve outcomes and survival.

More private sector collaboration
Last month, in a round table with a diverse and influential set of employers—representing more than 6.5 million American workers—to advance knowledge-sharing and best practices to make cancer screenings more accessible for their employees, new new actions aimed at improving equitable access and utilization of cancer screenings were announced.  These actions include:

  • United Airlines expands employee programs for cancer prevention, early detection, and quality care. As part of a dedicated push to remove barriers to access, wellness, and health care, United Airlines will expand a free skin cancer screening platform to all U.S. employees, and hold on-site screening events at seven hubs, increasing access for thousands of United team members. United will couple this expansion with educational campaigns about cancer risk factors to increase awareness and utilization of company cancer resources.
  • Target improves equitable access to cancer screenings through benefits offerings, like employee incentives to earn up to $500 annually by receiving recommended preventive care. Target’s medical plans include free care coordinators and second opinion services, and Target has lowered minimum average hours requirements to enroll in a medical plan from 30 to 25 hours per week, and has reduced waiting periods for new team members to become eligible for benefits.
  • Genentech will pilot a women’s health screening day this fall, including financial incentives, to provide employees with convenient access to preventive care and a holistic picture of their physical health. A mobile mammogram clinic will offer breast cancer screenings, and Genentech’s Campus Health Center providers will perform biometric and cervical cancer screenings and wellness exams, with colon cancer stool-based test kits available. Employees can earn up to $325 for completing these important steps in their preventive care.
  • Amazon will expand cancer screening by lowering access barriers. Amazon will expand a mobile mammography pilot in several medically underserved areas to lower barriers to screening. The company also offers free, direct access to at-home colorectal cancer screening for members of their national health plans. Furthermore, The Amazon Cancer Advocacy, Resources, Education, and Support (CARES) program provides high-touch, one-to-one support for employees—including hourly employees—and employee family members who have been diagnosed with cancer. This program is already available in 23 countries, and is expected to expand globally by 2024.
  • The Center for Construction Research and Training (CPWR) will scale screening activities for former construction workers employed in the Department of Energy’s (DOE’s) nuclear weapons facilities. Using a national network of medical providers located near where workers live, CPWR will increase educational efforts to ensure that all workers know what screening services are available to them and how to access these services. CPWR estimates that mortality has been reduced by 50% for workers who participate in the screenings compared to those who do not.
  • Gilead will increase employee cancer screening rates through personalized outreach. Using an existing health care navigation solution, advocates will engage employees who are eligible for cancer screenings proactively. In addition, Gilead will leverage internal oncology experts to identify leading-edge risk assessment and detection solutions to help employees identify actionable genetic variations and improve risk-based cancer early detection.
  • Lyft will launch a company-wide primary care, screening, and prevention campaign. Lyft’s health promotion campaign will focus on the importance of regular primary care visits and Lyft’s preventative screening coverage for employees, as well as encourage employees to use their monthly Lyft credits to visit their primary care provider or attend a screening appointment. Lyft employee credits help ease the burden of accessing transportation, which is often cited as a barrier to obtaining health care.
  • Hasbro removes access barriers to cancer care. Hasbro will remove cost barriers and provide a comprehensive suite of benefits to their employees, including free employee medical plans with concierge service; accessible cancer screening, results management, and navigation; and blood test screening for more than 50 cancers.
  • The American Cancer Society (ACS) and Color Health (Color) will provide free at-home screening, starting with colorectal cancer, with plans to expand to other at-home screening. Beginning in June 2024, ACS and Color will leverage partnerships with last-mile health organizations including Federally Qualified Health Centers and community health clinics to make at home-screening for colorectal cancer freely available, especially for people who are under- and uninsured. Individuals utilizing the at-home screening will also have access to diagnostic follow-up support through Color and ACS’s National Cancer Information Center for cancer screening information. The organizations will jointly share and disseminate initial findings from the new initiative in early 2025.
  • The Laborers’ Health & Safety Fund of North America (LHSFNA) will boost support for cancer prevention activities among the more than 500,000 Laborers’ International Union of North America (LIUNA) members and their families. The LHSFNA coordinates health screenings for Laborers and their family members at health fairs, and for over 20 years, the LHSFNA has run its annual Sun Sense campaign to raise awareness about skin cancer. The LHSFNA will scale social media efforts, and work with LIUNA health and welfare fund administrators to coordinate and produce direct member messaging to promote recommended preventive health care screenings and keep LIUNA membership engaged and informed.
  • Accolade is committed to offering its employees enhanced benefits aimed at improving cancer outcomes Accolade will offer benefits so that employees make use of all cancer screenings (United States Preventive Services Taskforce recommended and risk-based), virtual primary care visits, and expert second opinions, as well as access to specialized clinical partners to help Accolade employees and members get the care they need.

Reference
[1] Statement by Deputy Assistant to the President for the Cancer Moonshot Dr. Danielle Carnival on Biden-⁠Harris Administration’s new environmental actions in support of National Cancer Prevention & Early Detection Month. The White House. The White House April 10, 2024. Online. last accessed on may 1, 2024.
[2] A Proclamation on National Cancer Prevention and Early Detection Month, 2024. The White House. March 29, 2024. Online. last accessed on May 1, 2024.
[3] Private Sector Steps Up on Cancer Moonshot Call to Action on Cancer Screening. The White House. May 11, 20232. Online. last accesses on may 1, 2024.
[4] Epstein MM, Sundaresan D, Fair M, Fouayzi H, Warner ET, Garber LD, Gurwitz JH, Field TS. Trends in breast and prostate cancer screening and diagnostic procedures during the COVID-19 pandemic in central Massachusetts. Cancer Causes Control. 2022 Oct;33(10):1313-1323. doi: 10.1007/s10552-022-01616-4. Epub 2022 Aug 6. PMID: 35933572; PMCID: PMC9361987.
[5] Machii R, Takahashi H, Miyazawa J, Nakayama T. Cancer screening in Japan 2 years after the COVID-19 pandemic: Changes in participation, 2017-2021. Prev Med Rep. 2024 Feb 10;39:102649. doi: 10.1016/j.pmedr.2024.102649. PMID: 38375089; PMCID: PMC10875236.

Featured image by David Everett Strickler on Unsplash Used with permission.

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