Colorectal cancer is officially the leading cause death among younger men, according to a January report by the American Cancer Society. It is also the second leading cause for women under 50, after breast cancer. In fact, more than 10% of new colorectal cancer cases now occurring in people younger than 50.
The most effective way to reduce the risk of colorectal cancer is routine screening, e.g. colonoscopy, which the U.S. Centers for Disease Control and Prevention now recommends at age 45. These tests can find and remove precancerous polyps and spot cancer early, when treatment is most effective. (Almost 88% of adults diagnosed with colorectal cancer at an early stage live for five years or more, compared to only 16% of those diagnosed with late-stage cancer.)
Screenings are also beneficial for employers, who bear a large chunk of the medical costs associated with treating cancer: Cancer became the number-one driver of large companies’ healthcare costs last year, according to a 2023 survey published by the Business Group on Health, a nonprofit representing large-employer interests in healthcare policy. More than 13% of employers had seen more late-stage cancers. And rising rates of colorectal cancer are especially alarming, since it has the second-highest treatment cost of any type of cancer.
Thanks to provisions in the Affordable Care Act, most employer health plans cover age- and medically indicated screening tests for cancer. But because appointments can be hard to get and, well, no one wants a colonoscopy, many people don’t take advantage of the benefit.
Testing happens at home
Late last year, Burlingame, California-based health tech company Color Health (previously Color Genomics) offered employees—and their employers—a lifeline. Working alongside the American Cancer Society, it launched a cancer screening program as a novel workplace benefit that’s easy for employees to use and complements existing workplace health plans.
Employees who opt in to the program provide information about basic risk factors—family history, smoking habits—which helps determine their individual testing recommendations. “Something like three quarters of people have risk factors that deviate them from the norm,” says Color Health cofounder and CEO Othman Laraki. “But most people don’t get risk-adjusted guidelines from their primary care providers.”
If Color decides that the information puts the employee at a higher risk, it offers next-generation DNA sequencing—from a mail-in saliva sample—to identify “highly actionable, clinically valid” genetic markers associated with common adult-onset genetic disorders and medication response. This test, which costs a flat fee of $250, isn’t for disease, but it can identify, for example, BRCA gene mutations that increase the risk of developing breast and ovarian cancer that require extra vigilance in screening.
Then, Color delivers the appropriate ACS-recommended screening kits to the employee’s home. These typically include a DNA urine test for HPV (a leading cause of cervical cancer in women), PSA blood test for prostate cancer in men, and a FIT stool test for colorectal cancer. Then the samples are mailed back for analysis. For people at average risk, numerous studies show that these home-collection tests are as effective as testing in a doctor’s office or more invasive exams. “The best screening is one that’s completed,” says Alicia Zhou, Color’s chief science officer. Color can also help schedule recommended in-person screenings, such as mammograms or colonoscopies.
“When someone does a FIT test, there’s about a 5% to 10% probability they get an abnormal result that calls for further testing. And about 40% of people with those results don’t get any documented clinical follow-up. That’s a huge lost opportunity.” (More than 96% of people with an abnormal FIT result will not have cancer, but a 2022 study found that people who have a positive FIT result and don’t get a follow-up colonoscopy are twice as likely to die as those who do.)
Companies pay an average $150 per year for each employee who uses the Color program, including testing and followup, on top of any fee for the genetic testing. That is less than the cost for traditional fee-for-service models, according to the company. Laraki says it’s “about half of what it costs when people go through a traditional fee for service model.”
Unlike direct-to-consumer models such as 23andMe’s basic health and ancestry service, which offers data that users must parse themselves, Color functions as a telehealth provider, staffed by licensed doctors and counselors in 50 U.S. states, who interpret results, coordinate follow-up tests, make referrals, and communicate with a patient’s primary care doctor. (In November 2023, 23andMe launched a service that combines whole exome sequencing, lab-performed blood tests, and a telehealth clinic, for $99/a month.)
Hasbro and the Teamsters are early adopters
Because it acts as a healthcare service provider, Color is a HIPPA-covered entity. That means any data from tests can only be used for health purposes, and can’t be shared with third parties. though “there is an opt-in to consent for potential future research,” says Zhou. Employers do get access to aggregated data, though, such as the percentage of employees who have completed specific steps in the program offering. “We would not share specific test results,” Color’s counsel confirmed in an email.
That’s not necessarily the case for other “wellness” benefits out there, including genetic testing, that are offered as a voluntary benefit to employees, outside of their workplace health plan. “The protections for those programs are much less straightforward, and the average employee is less likely to understand how their data may be used,” says Kate Black, partner at Hintze Law in Miami, a boutique firm focusing on data, AI, privacy, and security.
Color’s employer program launched in October, and the first customers include toymaker Hasbro and the Teamsters Health & Welfare and Pension Funds of Philadelphia and Vicinity, which provides health benefits to 10,500 Teamsters, other union members, and their dependents. Maria Scheeler, administrator and executive director of the Teamsters funds, says she had to act after data revealed more than 3,300 claims of neoplasms (abnormal tissue growth that could be a tumor) in the first six months of 2023 among members, accounting for about 11% of total claims.
“There were very low numbers when it came to preventative screening,” says Scheeler. “Knowing our members as well as I know them, I knew that the way we were going about the problem wasn’t convenient. It was just a no-brainer to [make screening available] in the privacy of their homes.” With better prevention, says Scheeler, there will be savings—“and if you have savings, you can [further] enhance benefits.”
Today, “most of the money for cancer is spent on treatment,” Laraki says. Long-term survival for cancer has actually not really improved. By far, the most effective thing to do is to detect those cancers early.”