Lights illuminate the windows of the Discovery Ltd. headquarters office in the Sandton district of Johannesburg, South Africa. Photographer: Waldo Swiegers/Bloomberg
JOHANNESBURG - Cancer causes more deaths in South Africa than HIV/Aids, tuberculosis and malaria combined, and a special report by Discovery Health Medical Scheme (Discovery), released for the first time this year, quantifies the scheme’s spending on cancer-related claims and reinforces the need for greater cancer awareness.

The latest Discovery Health Healthcare Claims Tracker focuses on oncology claims, using the medical scheme’s claims data for 2017.

Discovery is South Africa’s largest open medical scheme, with a membership of 2.7million people as at the end of 2017. Its cancer incidence rate - the number of new cancer diagnoses per 100000 people a year - is higher than that for the South African population or the world population. The higher rate for the scheme, Discovery says, is because people are more likely to join a scheme when encountering health problems. This is what the medical scheme industry calls “anti-selection”, and it is detrimental to the scheme’s membership as a whole. Another reason the scheme figure is higher, Discovery says, is that it probably reflects a higher level of cancer screening among scheme members compared with the general population.

In 2017, 7597 Discovery members were newly diagnosed with cancer, which equates to an incidence of 277 new cases per 100000 lives. The incidence is up from 251 in 2011, an increase of 10%.

In the report, Discovery says the increase in new diagnoses over the six years is largely due to an ageing membership. “The average age of members increased from 32.8 to 34.5 over the period, and the proportion of members aged 60 and older increased from 11% to 14%.”

The report shows that incidence for adult men is higher than adult women (416 per 100000 against 329 per 100000, up 14% for men versus 5% for women since 2011). However, women are more prone than men to getting cancer earlier in life: men experience a significantly higher number of new cancer diagnoses compared with women from 56 years of age and older, whereas rates of new diagnosis are higher for women than men in the 35-to-55 age bracket, the report says.

Geographically, the Western Cape and Free State had the highest rates of new cancer cases in 2017 (339 per 100000 for the Western Cape and 333 per 100000 for the Free State). Limpopo and the Eastern Cape had the lowest incidence rates: 217 and 292 respectively.

The types of cancer most diagnosed through Discovery differ from the South African and global incidence rankings. For men, Discovery’s top three cancers are prostate (153 per 100000), colo-rectal (36 per 100000), and lung (21 per 100000).

The South African ranking also puts prostate cancer first, but has lung cancer second and colorectal cancer third. Globally, however, lung cancer tops the list for men, followed by prostate cancer and colorectal cancer.

For women, breast cancer is the most prevalent across the board, with Discovery reporting an incidence of 128 per 100000 in 2017. In second and third place for Discovery are colorectal cancer (27 per 100000) and lung cancer (21 per 100000). These top three are the same as the global top three. In South Africa, however, in second and third place to breast cancer, are cervical/uterine cancer and lung cancer.

The report also looks at the amounts spent on cancer cases. The average cost per cancer case per year (for new as well as ongoing cases) was R77644. This is up 17% from R66339 in 2011. However, even at the Consumer Price Index (CPI) inflation rate, which averaged 5.6% over the six years (and medical inflation is typically three percentage points above CPI), this represents a decrease in real (after-inflation) terms of 21%.

The top five cancers by cost were leukaemia (R281455 per case, on average), multiple myeloma (R228249), cancers of the central nervous system (R177185), lung cancer (R159622) and colorectal cancer (R119331).

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