Early detection saves lives

London seminar on Cancer in the Workplace outlines what employers can do toprotect their staff and their businesses – while representatives from HewlettPackard and Lend Lease explain how their organisations have benefited

HealthScreen UK seminar shows howbusinesses can make a difference inthe fight against cancer

Delegates from leading employers, health insurersand employee benefit consultancies gathered atHome House in London on 16 October 2014 to hearleading experts speak on the urgent need to addressthe issue of cancer in the workplace.

The breakfast seminar – introduced by StephenHackett, Head of Health and Risk, Aon RiskSolutions – revealed that currently one in threepeople in the UK will develop the disease in theirlifetime, with cancer charity Macmillan predictingthat this will rise to 47% by 2027. This not onlypresents a challenge to the individuals and cliniciansdirectly involved with it, but will also have asignificant negative impact on employers andinsurers if no proper strategy is put in place. Theseare the challenges that the seminar hoped toaddress.

The first speaker was Dr Pixie McKenna – ClinicalDirector, General Medical Services HealthScreenUK, but best known for her appearances as residentGP on the Channel 4 series Embarrassing Bodies –who explained that more people are now living withcancer than are dying from it. Survival rates havedoubled in the last decade, with 50% who getcancer surviving 10 years after diagnosis.

Nevertheless, the incidence of cancer is still on therise, she said. The core message to the audiencewas a stark one: “One in three people in this roomwill get cancer, and if it’s not you, it’s going to besomeone you love, someone you work with, or amember of your family”. Nevertheless, many peopleare still burying their heads in the sand, she said,with up to 25% of cancers presented at A&E, at avery late stage, with a very poor prognosis.

Looking at ways businesses manage illness in theworkplace, Dr McKenna divided their actions intotwo groups: the Proactive – including OccupationalHealth, Employee Assistance programmes, GPservices, WellMan and WellWoman clinics, Healthdays, Specialist services – and the Reactive,comprising such services as dental plans, cash backplans, Private Medical Insurance and life insurance.But while mostemployees see thelatter as ‘perks’, themore proactive effortstend to be overlooked,and Dr McKenna statedshe had seen littleadvance in this area inthe past 15 years,despite increasingincidence of cancer.

“More people arenow living with cancerthan are dying from it”

Early detection saves lives

Addressing the women in the room, she told them that by thetime they reach 25, they will have a 50%-60% of encounteringthe HPV virus, which is known to cause 99% of cervical cancers.Despite this potential early warning, HPV is currently not screenedby the NHS or most WellWoman clinics. For men, PSA testing isoffered to screen for prostate cancer as part of their medical, butthe tests are not infallible, and can result in unnecessarysecondary tests, which may in turn impact upon their insurancepremiums. With regard to skin cancer, Dr McKenna noted thatGPs have as little as seven minutes for an appointment, so do nothave the opportunity or the expertise to do a full skin check forsuspect moles.

In terms of assessing “corporate health”, Dr McKenna identifiedthe need to look at various factors, such as whether employeesspend a lot of time out of doors, which may prompt a need forskin cancer screening, whether the workforce is older, whichmight suggest prostate or bowel cancer screenings. They alsoneed to consider how they can introduce extra screening throughtheir benefits, and also what effect a positive result has on thosebenefits. Most employers have people in their care for at least 40hours a week, she said, and so also have a duty of care in termsof cancer prevention. It is also very important, she said, to choosethe right provider, with real expertise in testing and how to dealwith positive outcomes.

She shocked the audience with evidence from the US that simplysitting for prolonged periods increases cancer risk – so much sothat has led to the claim that “sitting is the new smoking”. In areport published in the JNCI: Journal of the National CancerInstitute, the highest levels of sedentary behaviour werecompared to the lowest, and researchers found a statistically

significant higher risk for three types of cancer – colon,endometrial, and lung. Moreover, the risk increased with eachtwo-hour increase in sitting time, 8% for colon cancer, 10% forendometrial cancer, and 6% for lung cancer. With stress also arisk factor, the office appears not to be the safe place wepreviously thought.

She emphasised the need for organisations to think about howthey will manage this situation, citing World Health Organisationreports indicating that the means already exist to greatly reducecancer – one third through changes in lifestyle, and a further thirdthrough the introduction of effective screening and education.

There is potential, therefore, for employers to reduce cancer by upto two thirds within their workforce, by engaging them withscreening techniques and education. She concluded bycommenting that there was a real opportunity for companies tobe proactive and do something for their employees before anymember of the workforce gets cancer.

Gordon Wishart, professor of cancer surgery, consultant breastand endocrine surgeon and Medical Director for HealthScreen UKbegan his presentation on cancer trends with a stark statement:“We are living in an epidemic of cancer”.

In the UK, there are 325,000 new cases of cancer every year, and160,000 deaths. While there are many different types of cancer,Prof Wishart listed six which account for about 88% of the total:breast, bowel, lung, skin, prostate and cervical cancer – the sixcancers that HealthScreen UK specifically targets in its screeningprogrammes.

He nonetheless demonstrated that it was possible to makeheadway in the fight against cancer. Giving the example of breastcancer, he showed that while incidence had increased, thenumber of deaths resulting from it has fallen as a result of greaterawareness, better education and improved methods of earlydetection. He also pointed out that survival rates were directlyrelated to the amount of GDP spent on cancer detection andtreatment.

Nevertheless, the incidence of breast cancer continues to rise.There are 50,000 new cases in the UK per annum (2010 figures),which means a lifetime risk of one in eight – predicted to be onein seven by 2024. There were 1.5 million cases diagnosedworldwide in 2010, predicted to rise to 2 million by 2030 – a hugehealth burden, globally.

The continuing rise was attributed to various lifestyle factors,including obesity and alcohol intake. Having no children or havingthem late in life, and not breast feeding, were also key factors. By

“In the UK, there are 325,000 newcases of cancer every year”

putting off having children in order to have both a career and afamily, therefore, women are putting themselves at increased risk.Shift work or working as part of a flight crew also increases risk. Athird of women in the UK work shift patterns that include anelement of night shift work, and over a prolonged period of timethis increases breast cancer risk by 50%. While working patternsare unlikely to change in the short term, early detection andincreased awareness – such as HealthScreen UK implement inworkplaces – can have a significant impact on the treatment andsurvival rate.

Prof Wishart then turned to lung cancer, for which survival ratesare, by contrast, very poor. 41,428 new cases were diagnosed inthe UK (2009), with 34,859 deaths (2010). The key reason for thehigh death rate is the difficulty of early detection with this cancer,resulting in around 90% of lung cancers presenting too late forsurgery or other treatments. Unlike breast cancer, there is nonational screening programme. He also highlighted the dangers ofCT scans used for initial screening – each of which exposes thebody to radiation equivalent to around 150 chest x-rays.

However, he revealed that there is now a simple blood test thatdetects seven antibodies made by the body in response to lungcancer at a very early stage. NHS Scotland is running arandomised trial of 5,000 men at high risk with a control group of5,000, comparing numbers of advanced lung cancers that presentin both groups. Recruitment to the study continues, and this testhas real potential to pick up lung cancers at a stage where theyare more treatable.

He cited similar opportunities with regard to prostate cancer andbowel cancer. Current tests used by the NHS for prostate cancerare not very reliable, missing some cases and also giving falsepositives, which can result in unnecessary biopsies. A far more

accurate blood test – used by HealthScreen UK – is now availableto pick up prostate cancer at an early stage. The test currentlyused by the NHS for bowel cancer also has a tendency to givefalse positive results; it is based on detecting blood in the faeces,but is unable to distinguish between human and animal blood. Anewer test, however, does make this distinction. This morereliable test is currently used by HealthScreen UK.

Prof Wishart then summarised the risk factors for skin cancer,emphasising the fact that those who are at risk of certain cancersare easily identifiable, and so they can be educated and screenedand their risk factors managed. This includes workforces whospend long periods outdoors and flight crews.

In the case of cervical cancer, Prof Wishart noted that manycountries have now switched from smear tests to screening forthe HPV virus, as this virus is ultimately responsible for nearly allcases of cervical cancer. He hoped the UK will go the same way,bolstered by a national programme to vaccinate girls at the age of12 or 13. There is also a simple self-administered test for HPVwhich can be done at home. The test is available exclusively fromGynaeHealth UK in the private sector and HealthScreen UK in thecorporate sector.

Prof Wishart emphasised that the way forward was not just aboutscreening, but also about education and awareness, andassessing the risks in each group, and HealthScreen UK hasworked with a number of companies to screen and raiseawareness in their workforces.

Representing one of those companies – Hewlett Packard – wasTotal Rewards Manager (UK & Ireland) Mark Osborn, who talkedabout the four large-scale screening programmes HealthScreenUK had undertaken for their employees.

He explained that HP has over 270,000 employees in 170countries, with 15,000 of these are based in the UK, spreadacross 60 sites. Employee wellbeing and wellness is a principleproject for the company; “Winning with Wellness” is HP’s globalprogramme, covering three key areas: physical wellbeing; stressmanagement and resilience and financial wellness. These not onlyoffer resources and services to the employee, but create betterengagement and productivity for the company – what he called a“win-win situation”. However, with medical inflation around 6-8%,the company was potentially exposed to rising costs of medicalinsurance.

It was in this context that HP launched its Power of Preventioncampaign, focused on four major cancers: breast, prostate, lungand skin. Mark reiterated some of the statistics referred to by ProfWishart, pointing out that skin cancer is now the number one

“resulting in around 90% of lung cancerspresenting too late for surgery or other

treatments”

cancer in the UK, with this country having now overtaken Australia.Using HealthScreen UK to implement the programmes, HP set outwith four key objectives: to raise awareness of cancer throughoutthe entire workforce; to ensure that people understood their ownrisk, via personal online assessment; to provide education, runninga number of sessions across HP sites using specialists, and toidentify cancers through a corporate screening programme. Thiswas paid for by the company itself, and was targeted not only atemployees, but also partners of employees

The first campaign, the Power ofPink, was a breast cancer campaign.Following the success of this, HP’sprostate campaign Be a Hero took abolder approach, targeting not onlypotential sufferers but also theirpartners, to raise awareness andencourage screenings. Next was theLove Your Lungs Lung cancercampaign. This brought its ownchallenges; Mark explained that thecompany did not wish to beperceived as a “Big Brotherorganisation simply telling employeesnot to smoke”. In this, HealthScreenUK were instrumental in helping pitchthe message for the audience.

The campaigns were a greatsuccess, with around 10,000employees being screened in total –about 27% of the eligible population.Within that, the prostate and breastcancer campaigns reached over 40%of the eligible workforce. From thescreenings, over 1,000 cases werereferred for further investigation, inpartnership with HealthScreen UK.These ultimately resulted in 65

cancers being detected early amongst employees or their partners.It was noted that within these were a handful of cases that hadbeen missed by NHS screening.

Mark explained that the business outcomes were ongoing, butwould mean reduced cost pressure on their medical scheme in thelonger term. Previously, the average cost of a cancer treatmentthrough a private medical scheme had been around £30,000 peremployee, but already average costs were showing less. They alsoexpected long-term reduction in absence costs, in early retirementcosts and life assurance premiums. Employee engagement alsoincreased 13% during the years the campaigns were run.

Feedback showed that 93% of those taking part rated theexperience as excellent, and there were numerous anecdotalcases of employees expressing gratitude for what the companyhad done for them. In general, HP felt they had broken downbarriers relating to what a company could talk to their employeesabout.

Next steps involved offering screenings as a voluntary benefit. Markexpressed satisfaction at seeing competitors following this lead –and also for the external recognition in terms of awards, includingEmployee and Healthcare award last year, and this year fromBusiness In The Community. Ultimate recognition came fromemployees, with one woman – whose breast cancer was detectedearly – stating: “I really believe working for HP saved my life”.

Mark then handed over to Gemma Bourne, Head of SocialSustainability, LendLease Europe – anAustralian propertycompany, whichoperates in Europe,the Americas, Asiaand Australia. As aresult of the workthey do, 18% of theworkforce operates

“93% of thosetaking part rated

the experienceas excellent”

outdoors, on site, which presents very specific challenges fordealing with their health and welfare. Gemma explained how, 30years ago, the founder of the company set up the Lend LeaseFoundation to invest in employees, their families and communities,and in the past 18 months this has focused more closely on healthand wellbeing. Part of this involved a health check, and thisrevealed that 52% did not protect themselves in the sun. Given therising levels of skin cancer, this was an alarming statistic, andprompted the company to consider how they could tackle theproblem in the workplace, with maximum flexibility andconvenience for employees.

Lend Lease approached HealthScreen UK in order to offeremployees skin cancer screenings at their place of work. Sessionstook just 30 minutes, and were conducted in “pop-up” clinics inspecially prepared offices and Portakabins. This not only screenedparticipating employees for cancer, but also educated theworkforce on the wider impact of skin damage from the sun,revealing “invisible” damage using advanced imaging equipment.Screenings were also timed to take place just before the summerholiday, in order to have maximum impact.

In total, 356 employees were given the all-clear, with 23 requiringfurther checks, and several being referred for urgent action.

Gemma explained that one of these individuals had a tiny mole onthe sole of his foot which he would never have seen himself, butthanks to the comprehensive screening process – involving a nursechecking every inch of his body – the cancer was picked up farearlier than it would otherwise have been. “Essentially,” saidGemma, “this saved his life.”

Lend Lease had run skin cancer checks before, but these were notas comprehensive – involving individuals choosing two moles thatthey wished to be checked, in contrast with the total body checkoffered by HeathScreen UK. Because of this previous experience,they had not expected uptake to be high – but the 200 placesoffered were booked up within an hour of going online. As a result,they doubled the number of places offered to 400, and plan todouble that to 800 next year.

Feedback was overwhelmingly positive, and Gemma emphasisedthat one of the key factors in making it such a success was theaccessibility and convenience of having the checks on-site,allowing employees to easily take up the opportunity without theirworking day being disrupted. Relatively, this was not an expensiveprocess for the company, she said, costing about £40,000, but ifthey saved 25 lives – or even just one – then it would be moneywell spent.

“In five years, cancerclaims cost has gone upfrom about 15% ofscheme spend to 20%”

Afterwards, delegates andspeakers who had gathered atHome House, London for theseminars, shared their thoughtsabout the event. This is whatsome of them said:

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Companies do have a role in informing, educating and raising the awareness ofcancer in the workplace amongst its employees. It’s something that affects all ofus, and companies absolutely can play their part in fighting cancer. We hadfeedback sent to HP that was truly humbling for all of us who read it. If you savejust one person’s life, then the campaign was absolutely worthwhile.

Mark Osborn HP Total Rewards Manager (UK & Ireland)

“I thought it was really helpful. I’ve been working in in-house HR for about nineyears and have seen cancer is something we’re having to deal with more and more.What was especially helpful today was that, as a company, we want to do more tohelp our employees, but we don’t always know how to go about that. We havetraditionally done more of the reactive stuff, so we have measures in place to helpyou when things are bad – income protection, life assurance, a private medicalscheme – but what we have not offered so much is this more pro-active, morepreventative approach. It’s really nice to see other companies that are doing it. Andfor us it will be about the boundaries, and talking about things that we haven’t talkedabout before. We often don’t talk about cancer openly – even those in the companywho are dealing with it – we don’t like to remind people about those things. But forme, as a reward manager, it shows other people are running successful campaigns.The other thing that was useful was the business case for it. £40,000 wasmentioned as a cost for potentially saving lives. In just saving one life we wouldspend more than that on private medical and life assurance. You can’t put a price onsomeone’s life from the perspective of their family, but even from a businessperspective it makes absolute sense.”

Jatinder Sanghera, FTI Consulting

Businesses are successful because of their people – without people you have nobusiness. So, I want people to take away from this that investing in your employees insuch a way really does have profound impacts and will make your business, andenvironment and culture a much better place to be. Sometimes it’s just the right thing todo, and forward-thinking companies will do it.

Gemma Bourne, Head of CSR at Lend Lease (EMEA)

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