- Testing can find pre-cancers and cancers early, before they can spread.
- Early detection may mean less treatment and less time spent recovering.
- Encouraging recommended screenings can help improve health equity.
Detecting cancers early saves lives, but all too often we delay or avoid our recommended screening tests. With that in mind, Cigna Healthcare is taking a number of steps to help plan members get the screening procedures they need.
For example, Cigna Healthcare partners with our clients to educate their employees when they are late to get recommended screenings for breast, cervical, and colorectal cancers. These tests can identify these cancers before they cause any symptoms.
“As part of this initiative, we reach out to a significant number of women,” said Jeanne Tamulonis, a director of population health for Cigna Healthcare. “It’s a win-win for patients and their plan sponsors, because all clients want to keep their employees healthy.”
By reaching out to individuals, these programs also help improve health equity among populations that historically are less likely to be tested regularly. According to statistics from the American Cancer Society, for example, 69% of black women and 65% of white women were up to date with their mammograms in 2021, compared with 47% of American Indian/Alaska Native women and 56% of Asian women living in the U.S. The percentage of Cigna Healthcare plan members who are up to date with their mammograms is even higher, at 71.42%.
“Women are less likely to die of cancer if they undergo regularly scheduled screening tests at the ages specified in guidelines,” said Dr. Robinson Ortiz, senior medical principal, oncology and hematology, for Cigna Healthcare. “Regular screenings can help find and treat pre-cancers and cancers early, before they have a chance to spread. Early detection may mean less treatment and less time spent recovering.”
Breast cancer: Ask your doctor about the need for annual screenings
Mammograms — the primary diagnostic tool for breast cancer — plummeted during the pandemic, with screenings down by almost 64% during its peak. While mammograms have rebounded, they have yet to reach their prepandemic peak.
The National Breast Cancer Foundation estimates that 1 in 8 women in the United States will be diagnosed with breast cancer. The five-year survival rate is 99% for cancer detected in early stages, before it has a chance to spread. About 280,000 women (and 2,800 men) will be diagnosed with breast cancer in 2023, the foundation estimates, and the disease will claim about 43,700 lives.
When women reach the age of 40, they should speak with their doctor about the need for a mammogram, said Karen Smallwood, a registered nurse on the population health team. The United States Preventative Services Task Force recommends that 50- to 74-year-old women who are at average risk get mammogram every other year. The American Cancer Society has slightly different recommendations: that women from 40 to 44 have the option for an annual mammogram; women 45 to 54 get mammograms each year; and women 55 or old continue to have annual mammograms or opt to have one every two years.
“When we reach out to women who haven’t had a recent mammogram, we suggest they speak with their doctor about the timing that’s right for them,” Smallwood said.
Cervical cancer: Two screening tests are key to early detection
The five-year survival rate for cervical cancer patients is improving all the time, but early detection is key. About 14,500 new cases will be diagnosed this year, according to the American Cancer Society, and about 4,000 women will die of cervical cancer.
For women diagnosed between 2012 and 2018 — the most recent statistics available — the American Cancer Society reports that women whose cancer had not spread had a five-year relative survival rate of 92%, compared with a 59% survival rate for women whose cancer had spread to nearby lymph nodes and a 17% survival rate for women whose cancer had spread more widely.
Regular screening is vital, because women with pre-cancers and early cervical cancer rarely have symptoms. Beginning at age 21, all women should receive a pap smear and be tested for human papillomavirus (HPV) annually, Smallwood said. While these tests do not diagnosis cancer, any abnormalities are a red flag that prompt further testing.
As with mammograms, Cigna Healthcare’s preventive care initiative reaches out to women who haven’t gotten these tests in a timely manner, Smallwood said.
Colorectal cancer: At-home tests can avoid the need for colonoscopies
Cigna Healthcare reaches out to health plan members without risk factors or a history of colon cancer and offers them a kit to collect a stool sample at home. After collecting the sample, they send the kit to a lab for analysis, Smallwood said. “Everyone 45 and older should have colon cancer screening,” she said. “This procedure is not invasive, and it can be done in the privacy of their home.”
In 2022, about 4% to 5% of the stool samples collected as part of the Cigna Healthcare initiative tested positive — which does not necessary mean the person has cancer, Smallwood said, but signals the need for a follow-up colonoscopy. The mail-in screening has been popular with people since it was launched almost 20 years ago, and it has grown even more popular over the years, she said.
Colon and rectal cancer screenings should start at age 45 for most people, although doctors may urge patients with additional risk factors to be screened at an earlier age. The American Cancer Society estimates that more than 153,000 Americans will be diagnosed this year with colon or rectal cancer, and these cancers will claim more than 52,000 lives. In the U.S., more than 1 in 24 people develop colon cancer; most will have experienced no symptoms, according to the Colon Cancer Coalition, which reports the disease is the second leading cause of cancer deaths, and the fourth most common type of cancer overall.
Using data to flag gaps in care and engage patients soon after a diagnosis
Cigna Healthcare utilizes claim records and billing information to determine when individuals are due for routine tests, then reaches out to their physicians and follows up with letters to the person. This ensures the doctors receive their letters first, in case their patient calls with questions, with the aim of increasing the likelihood that the screening is scheduled and performed.
When a preventive screening detects cancer, our predictive models help us improve the patient’s experience and outcomes. We look at data from a number of sources, including claims data, information from our customer service operations, myCigna.com and app data, screening and diagnostic codes, prior authorizations, and the use of specialty providers, to identify newly diagnosed patients and offer access to dedicated nurse advocates. By utilizing these predictive models, we are able to reach out to patients with breast cancer an average of 27 days earlier than standard models, according to our data. Patients with lung cancer are referred an average of 20 days earlier, and those with colorectal cancer see their referral time drop by an average of 34 days. We estimate that the additional savings from earlier identification and engagement to be more than $5,000 per patient.
These nurse advocates can help coordinate care, answer questions about health plan coverage and medical issues, provide regular check-in calls, and connect the patient with a wellness coach.
“This service — which is provided at no additional cost to patients or their plans — offers knowledgeable, actionable help during what can be an emotionally draining time to the person newly diagnosed with cancer and their entire family,” Tamulonis said. “This allows us to identify patients earlier in their cancer journey to help them through what can be a complicated or even overwhelming process.”