Role of Early Screening in Reducing the Economic Burden of Cancer

According to WHO, cancer is the second leading cause of death, in 2018, approximately 18.1 million new cases were reported and it leads to an estimated 9.6 million deaths. A key factor contributing to the dramatic rise in cancer cases is an increase in the global aging population, the changing lifestyle like physical inactivity, tobacco use, alcohol use, and unhealthy dietary habits. In addition, lack of awareness about early detection and treatment options in developing countries, inadequate healthcare infrastructure is resulting in cancer being identified at an advanced stage. Some of the leading types of cancers are lung, liver, colorectal, stomach, prostate and breast cancer respectively.

Cancer detection is a multistep process, where it entails a detailed examination of an individual. Traditionally, patients have to undergo different laboratory tests and are exposed to different imaging-based detection tests. Due to the side effects associated with radiation and morphological ambiguities in captured images, various alternative methods or non-image based tests are being explored that can identify tumor markers. Cancer is considered as one of the most expensive medical condition. The economic burden of cancer has been categorized into the direct cost (comprising of costs spent on screening, diagnosis, treatment, sedative care, and prevention) and indirect cost (consisting of productivity loss due to morbidity and also premature death among working-age group due to cancer). Post-operative care is more costly than diagnosis because currently most patients are diagnosed at an advanced stage of cancer and treatment regimens at this stage are more vigorous.

The cost incurred by the patients depends on the type of cancer. Also, it varies from region to region due to variation in healthcare policy and hospital. For instance, in the U.S. the average out of pocket spending on cancer per year is $1,592 compared to patients without cancer, In U.K. approximately, $627.9 is spent per month by 83% of the cancer patients and in Indian scenario, the average spending for lung cancer surgery ranges between $5,000 to $6,500 and 40% of the overall spending is on the diagnosis. According to the estimation by the National Sample Survey Organization, 20% of urban and 30% of rural people affected with lung cancer could not utilize medical care due to financial problems.

Over the past few years, to increase the survival of cancer patients has been attributed to tremendous increase in early cancer diagnostic techniques especially at the genetic level. The technology has developed in such a way that, cancer can be detected even before the onset of any symptoms. This method of diagnostic tests is based on antigen-antibody reaction, staining of cells/tissue for identifying the morphological changes from the normal cells/tissues or by studying the expression of individual genes. Insights from such diagnostic tests will aid in understanding of tumorigenesis, progression of cancer and this, in turn, will enable for rapid and precise decision making on cancer staging as well as assessing an individual’s response to therapy. Sometimes, genetic testing will be performed to detect susceptibility of an individual to cancer. The advent of non-image based cancer diagnostic methods has enabled the chances of decreasing the burden of cancer through different approaches such as early screening. According to IQ4I analysis, the global market for early diagnosis is growing at a strong CAGR of 9.8% from 2019 to 2026 to reach $2,954.3 million by 2026.

The rise in early screening will not only increase survival of patients but also decrease the economic burden on healthcare systems, in well-developed countries with advanced health facilities, cancer is being diagnosed in late stages, though most of the early diagnosis tests are available. For instance, the general survival of cancer patient is 5 years, but it could be extended if the cancer is diagnosed at an early stage, for instance, in India, the 5-year survival rate for women diagnosed with cervical cancer at an early stage is approximately 78% as compared to the late-stage diagnosis with 9% survival rate, whereas in advanced countries such as U.S., the survival rate if diagnosed at an early stage is 93% compared to stage 4 with 15% of survival rate with respect to cervical cancer.

Hence, at the primary care level, awareness should be created among the people regarding the importance of early screening. Many guidelines have been released for early screening as per the regulations of the individual countries. For instance, American Cancer Society screening guidelines says that, women aged 40 should go for breast cancer early screening every year, women aged 21 – 29 should go for pap test every 3 years once for the early detection of cervical cancer and for colorectal cancer, the average age to start the early screening is 45 years. Also reimbursement strategies have been implemented as to reduce the burden of screening cost on the individual. For example, cologuard (Exact Sciences Corporation, U.S.) is covered under Medicare, where ~74% of the people aged between 45 – 49 years don’t have to spend out of pocket for screening.

Overall, early detection of cancer is considered as a main strategy in preventing further spread of cancer and supports for cure, increase survival rate and also improve the quality of the patient thereby reducing the economic burden on the individual.

Some of the commercially available early detection tests are LIAISON fPSA for prostate cancer (Diasorin, Italy), Epi proColon for colorectal cancer (Epigenomics, Germany), EarlyCDT for lung cancer (Oncimmune, U.K.), Serum HER-2/neu for breast cancer (Siemens Healthineers, Germany), BRACAnalysis for breast and ovarian cancer and myRisk Hereditary Cancer for different types of cancer (Myriad Genetics, U.S.).

Some of the major players in cancer diagnostics global market are F. Hoffmann-La Roche AG (Switzerland), Danaher Corporation (U.S.), Siemens Healthineers (Germany), Hologic, Inc. (U.S.), Guardant Health (U.S.), Abbott Laboratories (U.S.), Qiagen (Netherlands), Exact Sciences Corp. (U.S.), Myriad Genetics, Inc. (U.S.) and Agilent Technologies (U.S.).

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