Cancer in the 21st Century


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As new research on cancer prevention, treatment and control progresses, there is much to celebrate in the war against cancer. More available cancer prevention information, earlier detection and an increase in treatment options all lead to people living longer. Over the years, state and federal policymakers and health officials have worked diligently to combat cancers by establishing a variety of programs and enacting laws.

However, most experts would agree that the battle is far from over. Cancer is one of the leading causes of death in the U.S. and, according to the American Association of Cancer Care, approximately $183 billion was spent on cancer-related care in 2015. The association estimates the cost of care will increase by 34% ―to $246 billion―by 2030. The American Cancer Society estimates that over 1.8 million new cases of cancer will have been diagnosed and more than 600,000 people will have died of cancer in the United States in 2020. Cancer rates vary by state, often related to historical differences in tobacco use and other lifestyle factors.

Even more grim, cancer has a disproportionate effect on African American populations. The U.S. Department of Health and Human Services Office of Minority Health reports that African Americans have lower five-year survival rates than any other racial and ethnic group. And, they are the most likely population to die from all major types of cancer compared to non-Hispanic white men and women.

As research and policy recommendations for cancer prevention, treatment, control and survivorship are constantly evolving, state and federal lawmakers may face challenges in staying updated and aware of cancer issues. The categories and topics below were derived from the input of scientific experts, patient organizations and other stakeholders who have a deep understanding of cancer-related policies. Please note NCSL provides links to third-party websites for information purposes only and providing these links does not indicate NCSL's support or endorsement of any material.

NCSL Resources:

Access to Care

Access to treatments and services can critically affect the outcomes of people living with cancer. Delays caused by barriers like affording an insurance copay, being uninsured or finding a provider within one’s network can all postpone or prevent screening and treatment. Policies like the Affordable Care Act and various state mandates have lowered some economic hurdles with zero copays for some cancer screenings and other prevention measures. Resources in this category underscore these issues.

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Access to Insurance

Access to care often hinges on what type of insurance coverage a person has, if any. These resources focus on that intersection.

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Coverage and Cost

A person’s insurance coverage, or lack thereof, often dictates how much they will pay out of pocket, including premiums, copayments, deductibles and coinsurance. Coverage and cost of treatments and prescription drugs are where consumers are likely to face these issues. Resources in this category emphasize this relationship.

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Biomarkers and Precision Medicine

Rather than killing tumor cells like traditional chemotherapy treatments, new targeted cancer therapies act on specific cancer related molecules to block tumor cell growth. Some therapies, like chemotherapy, work through a general mechanism of action. When a precise mechanism of action is known, a treatment can be developed which ‘targets’ a particular tumor. Targeted therapies are part of a broader transformative treatment option referred to as precision, or personalized, medicine.

Precision medicine—which customizes a patient’s treatment based on factors like a person’s genomic profile and physical environment—includes testing for biomarkers. A biomarker is a biological molecule, or molecular marker, found in blood, bodily fluids and tissues. Biomarker testing identifies changes in a person’s genes or proteins, whether disease process is present or not and can identify the specific characteristics of the person's disease. Biomarker testing also provides doctors with specific information about which, if any, targeted therapies might be effective, Biomarker testing may reduce the number of adverse drug reactions a person experiences and some studies link testing to increased chances of survival.

How is Biomarker Testing Used?

Biomarkers are often used in clinical trials and can aid in drug discovery. Instead of relying on natural endpoints such as survival rates, biomarkers can be used as surrogates. One study looking at medicines approved between 2015-2019 in the United States and Europe found approximately 65% were associated with at least one biomarker. On the other hand, some research argues against the use of biomarkers for this purpose, citing that overdependence on surrogate endpoints may lead to unsafe or ineffective treatments.

State Legislation
Arizona AZ HB 2144 Would require health insurance coverage of biomarker testing when supported by scientific evidence. Enacted

CA SB 535

Provides for health insurance coverage of genetic testing for various cancer mutations, effective Jan. 1, 2022. Enacted

California CA SB 912 Provides that biomarker testing shall be covered for the purposes of diagnosis, treatment, appropriate management or ongoing monitoring of a Medi-Cal beneficary's disease or condition only if the test is supported by medical and scientific evidence. Passed Assembly Appropriations Committee
Georgia GA HR 998 A resolution recognizing the benefits of biomarker testing as a necessary part of precision medicine; and for other purposes. Adopted.
Illinois IL HB 1779

Provides that a group or individual policy of accident and health insurance or managed care plan amended, delivered, issued, or renewed on or after Jan. 1, 2022, shall include coverage for biomarker testing. Enacted

Illinois IL HR 138 Declares March 2021 as Precision Medicine and Biomarker Testing Awareness Month in the State of Illinois. Enacted



A resolution designating the month of March, annually, as Precision Medicine and Biomarker Testing Awareness Month. Adopted

Louisiana LA SB 84

Requires insurance plans cover genetic and genomic testing including biomarker testing when medically indicated. Enacted

Louisiana LA SB 118

Makes amendments to SB 84: Clarifies testing must be covered when supported by the sources of evidence in the model bill. Passed House

Massachusetts         MA SB 808

Would remove prior authorization of biomarker testing when a person has metastatic stage 3 or 4 cancer. Introduced

Minnesota MN HF 4899 Health plans required to provide coverage for biomarker testing. Introduced.
New Hampshire NH HB 1290 Would establish a task force on precision medicine and biomarker testing. Referred for interim study.
New York NY SB 105 Would require health insurance policies to cover comprehensive genetic screening and FDA approved biomarker testing for ovarian and prostate cancers. Introduced
Ohio OH HB 608 Require health plan and Medicaid coverage of biomarker testing. Referred to health committee.
Rhode Island

RI HB 7587

RI SB 2201

Would requires health insurers, nonprofit hospital service corporations, nonprofit medical service corporations and health maintenance organizations that issue policies that provide coverage for biomarker testing on or after 1/1/23. Enacted.
Washington WA HB 1689 Would exempt biomarker testing from prior authorization for patients with late stage cancer. Enacted.

Federal Action

Passed in 2016, the bipartisan 21st Century Cures Act includes the Cancer Moonshot—research funded over seven years meant to boost progress in cancer care—and the Precision Medicine Initiative, a national data collection effort. An essential component of the act is developing a Human Tumor Atlas Network that will aid in identifying novel predictive biomarkers. Under the act, a three-stage submission process was developed to qualify biomarkers for use. Now, as the project concludes its fifth year, over $1 billion in funding has supported 240 research projects involving more than 70 organizations.

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Related Topics

Issues related to cancer are often interconnected and can be difficult to narrow into one topic area. Resources under this heading either cross all three topic areas (access, coverage and cost) or other subjects, including health equity and survivorship, which affect people of all ages. 

Addressing Health Equity and Disparities in Cancer Care

Cancer Survivorship

Currently, over 16.9 million Americans live in the cancer survivorship stage, which applies to people of all ages and encompasses issues like quality of life, risk of reoccurrence, financial hardship, and regaining and improving health through healthy behaviors. Survivorship also includes caregivers and families of people with cancer. Numerous policies can affect someone’s survivorship stage, as well as those around them. Please see the following links for more information.

Additional Resources 

  • With the Centers for Disease Control and Prevention's (CDC) Data Explorer, you can search data on six cancer types (lung, female breast, prostate, colorectal, kidney, and melanoma) from 27 cancer registries with new population-based geographies. Population-based geographies allow you to look at data changes related to environmental, community, and health, especially in areas where there are high or low populations in counties. These local data can help guide public health decisions regarding community-based actions and cancer screening services. Subcounty-level cancer data are also available.
  • The Centers for Disease Control and Prevention (CDC) has a wide range of cancer-related resources, including U.S. cancer statistics by state, resources for survivors and caregivers, and more.
  • CDC’s Division of Cancer Prevention and Control provides a wide variety of data, information and resources dedicated to cancer prevention for everyone.

NCSL provides links to third-party websites for information purposes only. Providing these links does not indicate NCSL's support or endorsement of any third-party site material. Use of brand or manufacturer names also are informational only. NCSL is not responsible for the opinions or facts on such sites.

NCSL would like to acknowledge Amgen for supporting this update.