Cancer Today and Cancer Tomorrow: Analysis of US Cancer Claims, 2007-2017

Cancer is the second leading cause of death in the United States and a major public health concern.^1,2 Claims data from private payers can illuminate many aspects of cancer prevalence

and trends over the past decade. In this article, we use data from our FAIR Health database of over 27 billion privately billed healthcare claims to identify the cancer diagnosis categories with the highest percentage of claim lines among all cancer diagnosis categories. As indicators of trends that may continue into the future, we also identify the cancer diagnosis categories with the greatest recent increases in relative claim line volume. In addition, we use claims data to shed light on patterns related to geography, gender, and age from pediatric patients to senior citizens. These patterns include the states with the most, and fewest, claims for certain cancer diagnoses as a percentage of all other medical claims in 2007 and 2017; the state referenced is the state where the services were performed and not where the patient resides.

Most Common Cancers Associated With Private Claims, 2007-2017

As shown in Figure 1, from 2007 to 2017, the most common cancer diagnoses associated with private insurance claim lines were, in order from most to least common:

1. Breast cancer
2. Prostate cancer
3. Cancer of the trachea, bronchus, and lung
4. Colon cancer
5. Cancer of lymphoid and histiocytic tissue
6. Multiple myeloma and immunoproliferative cancer
7. Lymphoid leukemia
8. Bladder cancer
9. Ovarian cancer, and
10. Malignant melanoma of skin

Breast cancer, at 18%, had the highest percentage of all cancer diagnosis claim lines from 2007 to 2017. Prostate cancer; trachea, bronchus, and lung cancer; and colon cancer, respectively, were second, third and fourth, with 8%, 7%, and 5% of all cancer claim lines. We did not include the category “neoplasms of uncertain behavior” as these lesions may or may not become malignant over time.

As in our list, the American Cancer Society (ACS) places breast cancer at the top of its list of specific cancers by estimated new cases in 2018.³ In the ACS list, lung and bronchus cancer rank second and prostate cancer is third compared with third and second, respectively, in our list. These and other variances may be attributable to differences in methodology or in the data underlying the studies. For example, although the ACS statistics are based on cancer registry data on unique individuals with a cancer diagnosis, we measured the number of claim lines representing services rendered to individuals with a particular cancer diagnosis.

Our analysis shows that, for the most part, there was only slight variation from 2007 to 2017 in the services associated with the most frequently occurring cancer diagnoses (Figure 2). The category that has shown the greatest increase in the number of claim lines at 51% is “multiple myeloma and immunoproliferative cancers,” a category that includes lymphoma and a variety of leukemia. One other category, lymphoid leukemia, had a slight increase in claim lines.

Breast Cancer

The maps below show the state-by-state distribution of breast cancer claim lines in 2007 and 2017 (Figures 3 and 4). Breast cancer diagnosis claim lines in 2007 were widely dispersed across the country. The states with the highest number of claim lines associated with breast cancer diagnoses as a percentage of all medical claim lines were New Mexico, Arkansas, West Virginia, and Mississippi. Washington, DC also made this list.

In 2017, although breast cancer diagnosis—related claim lines were still widely distributed, the dispersal of cases was somewhat different. The highest percentage of claim lines were seen in Arkansas; California; Washington, DC; Kansas; and Nevada.

As seen in Figure 5, in 2017, claim lines associated with breast cancer diagnoses were submitted most frequently for patients 51 to 60 years of age; 34% of total claim lines were associated with that age group. Individuals 61 to 70 years of age accounted for 26% of claim lines, followed by those 41 to 50 years of age, with 21% of claim lines. (Note that the claims data analyzed in this article do not include traditional Medicare but rather private insurance, including Medicare Advantage. If traditional Medicare data were included, claim line distribution might differ.)

Prostate Cancer

ACS statistics show that 6 of 10 cases of prostate cancer are diagnosed in men 65 and older and that this cancer is rarely seen in men under 40.⁴ Our data likewise support the association of prostate cancer with an older age group. In our analysis, claim lines for individuals 61 to 70 years dominate prostate cancer—related claims, representing 43% of the total. Claim lines for individuals over age 70 make up 32% of the distribution, and claim lines for individuals 51 to 60 years constitute 23%. Individuals younger than age 50 represent just 2.2% of total prostate cancer claim lines.

Trachea, Bronchus, and Lung Cancer

In 2007, the highest number of claim lines associated with diagnoses of trachea, bronchus, and lung cancer as a percentage of the total claim lines was found in Kentucky, Arkansas, Vermont, Delaware, and Nevada. In 2017, the states with the most claim lines associated with these diagnoses were Arkansas, Vermont, Iowa, Kansas, and Pennsylvania; Kentucky fell to number 16 in the list. This correlates with Surveillance, Epidemiology, and End Results Program data showing lung cancer incidence in Kentucky has decreased markedly since 2010.⁵

Colon Cancer

In 2007, colon cancer—related claim lines were somewhat geographically concentrated. The 5 states with the highest percentage of colon cancer–associated claim lines were Arkansas, Mississippi, Kentucky, West Virginia, and New Mexico, with all but New Mexico located in the South. Colon cancer claim lines were more widely dispersed in 2017, when the 5 states with the highest prevalence were Michigan, Arkansas, Kansas, Pennsylvania, and Florida.

In 2017, individuals in the 51-to-60 age group accounted for 34% of claim lines associated with colon cancer diagnoses; individuals in the 61-to-70 age group accounted for 27%. At 16% of the total, colon cancer—associated claim lines were less common but still notable in the 41-to-50 age group.

Colon cancer is more prevalent in males than in females in every age category, with males taking a 54% share of the claim lines among all age groups.

Cancers With the Greatest Increase in Claim Lines, 2007-2017

The sharpest growth in claim lines from 2007 to 2017 occurred in 2 cancer categories (Figure 6). With a 328% increase, claim lines associated with “other specified leukemia,” which includes erythremia and megakaryocytic leukemia, had the greatest growth of all categories. The second greatest increase in this period was in “lymphosarcoma and reticulosarcoma and other lymphatic malignant tumors,” which increased 230%.

Claim lines for liver, thyroid, and gum cancer increased 75%, 65%, and 64%, respectively, from 2007 to 2017. Claim lines related to a diagnosis of “multiple myeloma and immunoproliferative neoplasms” increased 51%. This diagnosis is also found among the most common cancer diagnoses associated with private insurance claim lines.

Other Specified Leukemias

Our data show a distinctive gender pattern for “other specified leukemias,” which includes tumors of the hematopoietic and lymphoid tissues (Figure 7). In this diagnostic group, pediatric patients (aged 0-18) are overwhelmingly female (71%) and all other age groups are predominantly male (55%-65%).

Pediatric patients account for 16% of diagnosis-related claims in the other specified leukemias category. The 51-to-60, 61-to-70, and 71-to-80 age groups have similar distributions, accounting for 17%, 23%, and 14% of claim lines, respectively. The diagnosis appears to be uncommon in individuals 19 to 50 years of age.

Lymphosarcoma and Reticulosarcoma

In 2007, the highest percentage of medical claim lines related to the diagnosis “lymphosarcoma and reticulosarcoma and other lymphatic malignant tumors” was found in Iowa; Wisconsin; Washington, DC; Louisiana; and Texas (Figure 8). The lowest percentages were found in Wyoming, Hawaii, Maine, Montana, Vermont, and North Carolina.

In 2017, claim lines for this diagnosis were much more widely dispersed. The states with the highest percentage of claim lines for this category were Rhode Island, Wyoming, North Carolina, Kentucky, and Hawaii (Figure 9). Interestingly, Wyoming, North Carolina, and Hawaii were among the states with the fewest claims for this category in 2007.

Liver Cancer

“Neoplasms of the liver and intrahepatic bile ducts,” liver cancer, is a diagnostic category in which the landscape has changed greatly in the last decade. In 2007, diagnosis-related claim

lines were not widespread and were seen most frequently in Vermont; Nevada; Washington, DC; Arkansas; and New York (Figure 10). By 2017, liver cancer—related claims were dispersed throughout the country (Figure 11). The states with the highest prevalence in 2017 were South Dakota, New Hampshire, North Dakota, Rhode Island, and Mississippi. The change in distribution may be related to an increase in medical services available for liver cancer.

Claims data show liver cancer is found most frequently in individuals aged 61 to 70 years, who account for 40% of the total (Figure 12). Individuals 51 to 60 years of account for another 29% of claims. Risk of liver cancer is increased by chronic hepatitis C (HCV) infection, the prevalence of which has been found to be highest among adults born from 1945 to 1965 due to the large number of HCV infections that occurred during the 1970s and 1980s.⁶

Thyroid Cancer

Individuals in the 41-to-50 and 51-to-60 age groups together account for 52% of claims (Figure 13). Individuals in the 19-to-30 and 31-to-40 age groups account for 25% of claims, which is high for those demographics compared with the percentage of new cancers overall in younger adults: SEER data show individuals aged 20 to 44 years account for only about 8% of new cancers.⁷ Thyroid cancer is found overwhelmingly in females (75% of all diagnosis-related claim lines) compared with males. This correlates with data from the American Society of Clinical Oncology, which show females account for 3 of 4 thyroid cancer diagnoses and two-thirds of all thyroid cancers are diagnosed in individuals aged 20 to 55.⁸

Conclusions

Today, breast cancer leads the list of the most common cancer diagnoses, as reflected in private healthcare claims across the country. From 2007 to 2017, there has been only slight variation in the frequency of claim lines for those diagnoses. How cancer will change tomorrow is uncertain, but from 2007 to 2017, the highest growth in claim lines for cancer was in the categories “other specified leukemia” and “lymphosarcoma and reticulosarcoma and other lymphatic malignant tumors.” FAIR Health releases findings from our comprehensive claims collection in order to help fuel further research.AUTHOR INFORMATION

Robin Gelburd, JD, is the president of FAIR Health, a national independent nonprofit organization with the mission of bringing transparency to healthcare costs and health insurance information. FAIR Health possesses the nation’s largest collection of private healthcare claims data, which includes over 27 billion claim records contributed by payers and administrators who insure or process claims for private insurance plans covering more than 150 million individuals. FAIR Health also holds separate data representing the experiences of all individuals enrolled in traditional Medicare, from 2013 to the present, as well as Medicare Advantage enrollees represented in its private claims data. Certified by the Centers for Medicare & Medicaid Services as a Qualified Entity, FAIR Health receives all of Medicare Parts A, B, and D claims data for use in nationwide transparency efforts. Ms. Gelburd is a nationally recognized expert on healthcare policy, data and transparency.REFERENCES

1. US Cancer Statistics Working Group. Leading cancer cases and deaths, male and female, 2015. Centers for Disease Control and Prevention website. gis.cdc.gov/cancer/USCS/DataViz.html. Accessed September 25, 2018.
2. Weir HK, Anderson RN, Coleman King SM, et al. Heart disease and cancer deaths—trends and projections in the United States, 1969—2020. Prev Chronic Dis. 2016;13:E157. doi: 10.5888/pcd13.160211.
3. American Cancer Society. Cancer statistics center: 2018 estimates. ACS website. cancerstatisticscenter.cancer.org/#!/. Accessed September 27, 2018.
4. American Cancer Society. Key statistics for prostate cancer. ACS website. cancer.org/cancer/prostate-cancer/about/key-statistics.html. Accessed September 25, 2018.
5. CDC and National Cancer Institute. State cancer profiles. NCI website. statecancerprofiles.cancer.gov/historicaltrend/index.php?0&4221&99 9&7599&001&047&00&0&0&0&1&0&1&1#results. Accessed September 25, 2018.
6. White MC, Holman DM, Boehm JE, Peipins LA, Grossman M, Henley SJ. Age and cancer risk: a potentially modifiable relationship. Am J Prev Med. 2014;46(3 supple 1):S7-S15. doi: 10.1016/j.amepre.2013.10.029.
7. National Cancer Institute. Age and cancer risk. NCI website. cancer.gov/ about-cancer/causes-prevention/risk/age. Accessed October 2, 2018.
8. Thyroid cancer: risk factors. Cancer.net website. cancer.net/cancer-types/thyroid-cancer/risk-factors. Accessed October 3, 2018.

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