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.

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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/precision medicine

Biomarker Testing

According to the National Cancer Institute, biomarker testing is a method to look for genes, proteins and other substances (called biomarkers or tumor markers) that can provide more personalized information about cancer. While biomarker testing can be conducted in a multitude of ways, the most common is removing a small mass of material from the cancer or tumor and examining its genetic code. Biomarkers can be measured using blood, skin tissue, muscle tissue, organ tissue, tumor tissue and bodily fluids.

How is Biomarker Testing Used?

Diseases and their treatments affect people differently. Biomarker testing provides doctors and researchers more specific information about how to treat an individual’s disease. These customized treatments may also be called precision medicine, personalized medicine or personalized care. Precision medicine looks at how a specific gene change or mutation might affect a person's risk of developing cancer or how a person’s genes might respond to treatment options. When used appropriately, precision medicine may lead to more effective prevention and treatment measures for many illnesses and diseases. Research has demonstrated the effectiveness of precision medicine for ailments including:

Biomarker Testing FAQ’s

Q: What happens to the information gathered during biomarker testing?

A: The data is scrubbed of personal identifying information and stored in research databases.

Q: Is biomarker testing dangerous?

A: Biomarker testing is conducted by medical professionals in safe and sterile in-patient settings like hospitals, clinics and doctors’ offices. Samples may also be taken during surgery.

Q: Do biomarker testing results affect insurance coverage?

A: Because biomarker testing can reveal an individual’s risk for health issues this can be a concern for patients. Some lawmakers are proposing legislation to address this issue. For example, in 2020 California passed AB 2640, which states that health insurance providers cannot require biomarker testing for potential subscribers who have preexisting cancer conditions.

Federal Action

In 2015, then-President Barack Obama launched the Precision Medicine Initiative, which prompted advancements in medical research like biomarker testing.

State Legislation
California CA SB 535

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

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



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

Massachusetts         MA SB 808

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

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. Please see the following links for more information.

Additional Resources

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.