Lack of Early Screening Leads to Late Diagnoses

In most cases, patients who are diagnosed with cancer at earlier stages show improved survival, clinical outcomes, and quality of life. However, screening for earlier cancer detection remains limited. Today, broad-based cancer screenings for asymptomatic patients are recommended in the US for just 5 cancer types (breast, cervical, colorectal, lung for a high-risk subset of the population, and prostate). Further, we know that 71% of all cancer mortality is from cancers that lack broad-based screenings for asymptomatic patients.

Earlier Cancer Diagnoses Result in Improved Survival

Patients diagnosed with earlier stages of cancer (stage I-II) generally have a higher likelihood of recovery than those diagnosed at a later stage (stage III-IV). For non-small cell lung cancer (NSCLC), stomach, and pancreatic cancers, between 36% and 53% of patients are diagnosed with stage IV cancer, where the cancer has spread to other parts of the body, decreasing survival chances.

Sources: C. Zappa, and S. A. Mousa, “Non-Small Cell Lung Cancer: Current Treatment and Future Advances,” Translational Lung Cancer Research 5.3 (2016): 288–300; The American Cancer Society, “Key Statistics About Stomach Cancer” (2020); American Society of Clinical Oncology, “Pancreatic Cancer: Statistics” (2020); Ping Yang, “Epidemiology of Lung Cancer Prognosis: Quantity and Quality of Life, Methods of Molecular Biology (2020); NIH, “Cancer Stat Facts: Stomach Cancer” (2020).

The 5-year survival rate for non-small-cell lung cancer (NSCLC), stomach, and pancreatic more than doubles in all cases when detected at earlier stages These differences in survival rates underscore the opportunity to make progress in beating cancer by decreasing late-stage diagnoses with improved and expanded screenings.

Earlier Diagnoses Increase Treatment Options, Improve Quality of Life, and Reduce Costs

For NSCLC, stomach, and pancreatic cancers, the number of treatment options available increases and there are likely to be fewer resources used when the cancer is detected earlier. Additionally, quality of life, for both patients and their caregivers, is often improved if patients are able to receive treatment at an earlier stage of disease compared to later stage treatment. For example, as patients progress through more extensive treatment necessitated by later stage diagnoses their perceived quality of life goes down including through physical, emotional, and social functioning.

Late-stage diagnoses often require more intensive and more invasive interventions that resulting sometimes difficult and lasting side effects. For example, patients with late-stage NSCLC diagnosis often suffer from dyspnea, or labored breathing, after their treatment is complete. Similarly, stomach cancer patients recovering from a partial or full gastrectomy followed by other treatments such as chemotherapy, radiation, and immunotherapy in late stages may suffer from chronic fatigue, difficulty eating, and challenges performing everyday activities.

Later stage diagnoses may also mean that effective interventions are limited, leaving patients with palliative care options that may help reduce pain or alleviate other disease symptoms, but do not alter the course of disease or extend life. For example, often pancreatic cancer patients diagnosed in later stages have limited treatment options to extend life, and they often have side effects that may cause patients to feel sick and experience weight loss and the inability to care for themselves. Patients diagnosed in earlier stages are often able to retain more of their lifestyle pre-diagnosis, such as continuing to work and providing childcare.

Resources, services, and treatments increase as stage of diagnosis increases. In 2015, the most recent year of available data, the mean total 1-year costs for lung cancer ranged from $50,700 (stage I) to $97,400 (stage IV) among patients under 65 years and from $44,000 (stage I) to $71,200 (stage IV) among patients over age 65. Additionally, the annualized average costs for prescription drugs to treat lung cancer more than quadruples in late-stage diagnosis.

Further, shifting diagnoses to earlier stages of disease would have a particularly notable impact on certain populations that are disproportionately affected by cancer. For example, socioeconomic, racial, ethnic, geographic, age, and sex-based factors are associated with increased risk for NSCLC, stomach, and pancreatic cancers. Specific underserved demographics, including communities of color and rural Americans, also experience disparities in cancer incidence and mortality. Improving early screening could play an important role in helping to begin to reduce these types of disparities in stage of diagnosis that have major impacts on mortality and survival outcomes.

Sources: American Cancer Society, “Cancer Facts and Figures 2019” (2019); American Cancer Society, “Cancer Facts and Figures for Hispanics/Latinos 2018–2020” (2020); A. Florea, H. Brown, R. Harris, and E. Oren, “Ethnic Disparities in Gastric Cancer Presentation and Screening Practice in the United States: Analysis of 1997–2010 Surveillance, Epidemiology, and End Results-Medicare Data,” Cancer Epidemiol Biomarkers (2019); Pancreatic Cancer Action Network, “Black Americans at Increased Risk for Pancreatic Cancer” (2019); Health and Human Services: Office of Minority Health. “Cancer and Hispanic Americans” (2020).

Conclusion

Earlier cancer detection remains a significant unmet need for patients, and an opportunity for the healthcare system. The many cancers without broad-based screenings lead to later-stage diagnosis, often with lower survival rates and increased burden on the healthcare system. There is an opportunity to extend screening and earlier detection to many more cancers, thereby helping drive better cancer outcomes, including improved survival and quality of life.

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GRAIL provided funding for this work, Avalere retained final editorial control of content.

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