Is Your Business Prepared for Rising Cancer Costs?

JULY 1, 2025

Cancer is a top cost driver for employer-sponsored health plans. The direct medical cost of cancer care in the United States is over $200 billion, according to estimates from the National Cancer Institute (NCI) and Centers for Disease Control and Prevention (CDC).1 Of that amount, employer-sponsored health plans paid roughly $57.8 billion, or 28.9% of the total direct medical costs.

The NCI estimates nearly 40% of men and women will be diagnosed with cancer at some point during their lifetimes — and the rates of cancer are expected to rise. The World Health Organization (WHO) expects the incidence of new cancer cases to increase globally by 2050, as much as 48.5% in North America.2 The U.S. has already seen an alarming surge in certain cancers within the working-age population:

  • Colon cancer is now the leading cancer in people ages 20 to 49.3
  • Newly diagnosed breast cancer rates for women ages 20 to 49 have risen twice as fast as the rates for women older than 50 over the past two decades.4

Early detection has the greatest impact on health outcomes and total health plan spending:

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Primary care engagement is the most efficient and effective way to promote general preventive care, including cancer screenings based on age and gender. However, USI has found that only 50% of adult plan members receive annual preventive care, and half of catastrophic claims over $50,000 have been tied to individuals who have not had any preventive care in the past year.5 Getting more employees to engage with annual preventive care services can help improve health outcomes while reducing the impact on employer health plan spending.

How USI Can Help

Connecting members to primary care is the best first step to improved healthcare and chronic condition management. USI’s incentivized physician engagement strategy promotes annual preventive care visits, which can help increase recommended cancer screenings — leading to early detection and lower costs of care. Primary care engagement can also reduce emergency room visits, hospitalizations, and re-admission rates.

We have found that employers can increase primary care engagement 50% to 80% by offering financial incentives — such as premium reductions or HSA contributions — to plan members who complete their annual visits and recommended screenings.

USI uses advanced data analytics to help clients identify cost drivers and the potential impact of cancer claims on their health plan spending. For employers with cancer claims exposure, our population health management team reviews existing cancer benefits and makes strategic recommendations to address gaps or needs. We leverage extensive marketplace knowledge to evaluate and implement additional cancer management solutions where appropriate, such as:

Medical second opinion – Seeking a second opinion often results in a different diagnosis and treatment plan, which may involve less invasive procedures and lower costs.

Specialized care facilities – 77% of cancer care is delivered in community-based hospitals, which tend to have worse patient outcomes. Connecting plan members with specialized care facilities can help patients access expert cancer care, regardless of where they receive treatment.

Post-treatment care – Cancer patients may need ongoing care post-treatment, such as: palliative care to help manage symptoms, ongoing pain, or stress; physical therapy to help regain strength and movement; occupational therapy to help improve daily living activities; and assistance returning to work.

Need more detailed guidance?

USI continuously monitors advancements in cancer screening diagnostics, including:

In-home testing – While in-home colon cancer screening does not replace a colonoscopy, these test kits are 96% effective at detecting DNA from cancerous tumors.

Blood testing – Although not as effective as in-home testing, this may provide a less invasive alternative to a colonoscopy, though additional screening would be necessary for a full diagnosis.

Genetic testing – This can be used to determine an individual’s cancer risk and how a cancer patient may respond to certain treatments. Though not recommended for the general population, genetic testing is frequently incorporated into cancer treatment plans. Individuals with an immediate family history of cancer should discuss genetic testing options with their medical provider.

Use of AI in screenings – AI-assisted mammograms correctly identify about 87% of cancer at the time of screening, and AI has improved colon cancer detection rates by 50%.6,7 To improve accuracy, researchers are investigating whether AI software can assist radiologists in identifying cancers more effectively. Though AI-supported screenings are new, many hospitals have begun adopting this technology, and it may eventually become part of standard care for breast and colon cancer detection.

USI has the expertise to help your organization evaluate risk and determine appropriate solutions. Contact your local USI benefits consultant or email ebsolutions@usi.com to learn more.

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