The financial costs of cancer are great both for the individual and for the society as a whole. In the year 2000, the National Institutes of Health estimate overall annual costs for cancer as follows:

• Total Cost: $180.2 billion
• Direct Medical Costs: $60 billion (total of all health expenditures)
• Indirect Morbidity Costs: $15 billion (cost of lost productivity due to illness)
• Indirect Mortality Costs: $105.2 billion (cost of lost productivity due to premature death)

Over half of the direct medical costs are due to treatment of breast ($6 billion), lung ($5 billion), and prostate ($5 billion) cancers. These estimates are annual aggregate expenditures expressed in 1990 dollars. The cost of cancer screenings, including mammograms, Pap smears, and colorectal exams adds another $3 to $4 billion to overall cancer costs.

Tobacco use drains the US economy of more than $100 billion in health care costs and productivity. Health care expenditures caused directly by smoking totaled $50 billion in 1993, according to the Centers for Disease Control and Prevention. Adjusted for inflation, the total economic cost of smoking is more than $100 billion per year. This does not include costs associated with diseases caused by environmental tobacco smoke, burn care resulting from cigarette smoking-related fires, or perinatal care for low-birthweight infants of mothers who smoke.

Individual medical costs may be covered by private insurance companies or public health insurance programs such as Medicare, Medicaid, and Veterans Affairs. Most of the non-elderly population receive their primary coverage through employment-based group insurance. Medicare covers medical costs for those over 65 and the disabled, about 35 million people in 1991. Medicaid serves the socio-economically disadvantaged and handicapped under age 65, covering about 28 million people. According to 1997 data, about 17% of Americans under age 65 have no health insurance, and about 21% of older individuals have only Medicare coverage. During 1997 and 1998, almost 18% of Americans age 18 to 64 years reported not having a usual source of health care. Also, 12% of American families had members who experienced delay in obtaining care or did not receive needed health care services. Almost 10% of American adults reported cost as a barrier to obtaining needed health care in the previous year.

LEGISLATION

Traditionally, private and public insurers have been reluctant to cover cancer screening exams. In 1989 and 1990, Congress passed legislation mandating Medicare coverage for cervical and breast cancer screening, respectively. For women over age 65, Medicare currently covers Pap smear screening once every three years (or more often if necessary) and as of January 1, 1998 annual mammogram screening for women over age 39.

REFERENCES

American Cancer Society. Cancer Facts and Figures 2000. Atlanta, GA: American Cancer Society, 2000.

American Cancer Society. Cancer Facts and Figures 2001. Atlanta, GA: American Cancer Society, 2001.

Brown, MS. Special Report: The National Economic Burden of Cancer: An Update. JNCI 1990; 82: 1811-1814.

Brown, MS, Fintor, L. The Economic Burden of Cancer: Cancer Prevention and Control. National Cancer Institute 1995.

Graves, Edmund J. Expected Principal Source of Payment for Hospital Discharges, U.S., 1990. National Center for Health Statistics: Vital Health Statistics; 220: 1992.

New Database Allows Researchers to Evaluate Cancer Care Costs: JNCI, March 3, 1993; 85: 351.


Revised: 3/20/2000