This policy establishes a process for worksites to support all employees who are eligible for breast, cervical, lung and colorectal cancer screening.

Cancer was the second leading cause of death in South Dakota in 2018, with 4,820 cancer cases diagnosed and 1,661 deaths. This equates to one in four deaths in South Dakota being attributable to cancer. The five most diagnosed cancer sites (prostate, female breast, lung, colorectal, melanoma) accounted for 55% of all cancer cases. Of those, female breast accounted for 13.6% of all cases and 28.9% of cases for women, and colorectal accounted for 8.5% of all cancer cases. In addition, colorectal cancer was the second leading cause of cancer deaths in 2018 (10.1% of all cancer deaths), and female breast cancer was the fourth leading cause of cancer deaths (6.7% of all cancer deaths and 14.9% of all female cancer deaths).1

Completing recommended cancer screening tests may find breast, cervical, lung and colorectal cancers early when treatment is likely to work best.2 In addition, regular screening for cervical and colorectal cancer can detect abnormalities that can be treated or removed before cancer has formed.  The availability of paid time off* from work for cancer screenings alleviates a significant barrier and encourages employees to see a doctor before they develop a serious illness. Studies have identified a positive relationship between paid leave benefits and both undergoing preventive cancer screenings and making routine medical visits. The Affordable Care Act ensures most individuals have a health insurance plan that covers preventive care services at no out-of-pocket cost. However, without paid time off to access covered services, many employees will not fully benefit from their insurance coverage. 3

Paid leave for cancer screenings that are not deducted from other sick or vacation time may specifically encourage employees to obtain age-appropriate screenings.Each cancer diagnosis is estimated to cost a business $1,601 annually in lost productivity. Early detection of breast, colorectal and cervical cancer dramatically improves treatment outcomes. Moreover, research suggests that employers can provide paid leave with no negative effect on profitability. Employers who offer paid leave may realize a healthier and more productive workforce and spend less on direct medical costs, worker compensation and disability costs, replacement costs for ill or injured workers who are absent, and costs for recruiting and training new workers.3

*For the sake of this model policy, “paid time off” refers to any policy that provides paid hours off that may be used for the employee to complete breast, cervical, and/or colorectal cancer screenings.

Policy Guidelines

Early detection and screening are the best ways to prevent or find cancer in the earliest stages when treatment often leads to a cure. The first step to creating a worksite that supports cancer screening for all employees is to utilize this model policy in its entirety or adapt this model policy to support employee screening.

  1. [Employer] is committed to providing paid time off annually for employees to complete screenings for cervical cancer [and/or] breast cancer [and/or] lung cancer [and/or] colorectal cancer.
  2. [Employer] is committed to promoting this policy and providing its employees with evidence-based education to make informed decisions about screening.
  3. [Employer] is committed to implementing evidence-based interventions, such as annual reminders to eligible employees, to increase screening completion.
  4. [Employer] will encourage employees age 45-75 to be screened for colorectal cancer.
  5. [Employer] will encourage female employees age 21-65 to be screened for cervical cancer.
  6. [Employer] will encourage female employees age 50-74 to be screened for breast cancer.
  7. [Employer] will encourage employees age 50-80 years who have a 20 pack year smoking history and currently smoke or have quit within the past 15 years to be screened for lung cancer. 


The guidelines below provide suggestions for implementing this policy and increasing preventative cancer screening rates among employees.

Paid Leave Requests
When providing paid leave for employees to complete cancer screening, employers may wish to request a written recommendation from the employee’s healthcare provider that includes the type of cancer screening and test.  The timeframe to complete cancer screening varies by test; however, the following can be used as a guideline for paid leave requests.

TestLength of paid leave
Colonoscopy1 day
Sigmoidoscopy1 day
CT Colonography2 hours
FOBT, FIT, FIT-DNA (at-home stool tests)No time off
Mammogram1-2 hours
Pap smear1-2 hours
Low-dose CT scan1-2 hours

Employee Reminders
The use of reminders to increase cancer screening rates is highly recommended based on strong evidence of effectiveness.4 Employers can collaborate with their health plan to send reminders to employees who are due for screening.  These reminders should include recommended screening guidelines, coverage of preventive services and contact information for the health plan.  Employers and health plans can also track the results of these reminders to determine effectiveness.


Use the above policy language as a guide for your worksite. Implementing a policy that will fit your worksite and benefit your employees is the overall goal and policy compliance should be considered for this purpose. Your worksite wellness committee may be the perfect group to ensure this policy will remain a priority.  As mandated by the Affordable Care Act, all Marketplace health plans and all non-grandfathered health plans must cover certain preventative cancer screening services for men and women based on recommendations from the U.S. Preventive Services Task Force without charging a copayment or coinsurance.

Final Statement

By implementing this model policy in its entirety or choosing to tailor this policy to your worksite’s needs, you are taking an important step to increase cancer screening for your employees.

Definition of Terms

Sigmoidoscopy: The doctor uses a short, thin, flexible, lighted tube that is inserted into the rectum. The doctor checks for polyps or cancer inside the rectum and lower third of the colon. 

Colonoscopy: This is similar to flexible sigmoidoscopy, except the doctor uses a longer, thin, flexible, lighted tube to check for polyps or cancer inside the rectum and the entire colon. During the test, the doctor can find and remove most polyps and some cancers. Colonoscopy also is used as a follow-up test if anything unusual is found during one of the other screening tests.

High sensitivity Fecal Occult Blood Test (FOBT): This is a take home stool test that can check for tiny amounts of blood in the stool.

Fecal Immunochemical Test (FIT): This is a take-home stool test that can check for tiny amounts of blood in the stool.

FIT-DNA: This is a take-home stool test that can check for tiny amounts of blood in the stool.

Mammogram: A mammogram is an x-ray of the breast.

Pam smear: A sample of cells from the cervix are collected during an exam by a healthcare provider.  These cells are sent to a lab to be checked by an expert for pre-cancer and cancer changes.

Low-Dose Computed Tomography (LDCT): Scanning combines special x-ray equipment with sophisticated computers to produce multiple, cross-sectional images or pictures of the inside of the body. Low-dose CT uses less ionizing radiation than a conventional CT scan.

Pack year: A pack year is smoking an average of one pack of cigarettes per day for one year. For example, a person could have a 20 pack-year history by smoking one pack a day for 20 years or two packs a day for 10 years.


  1. South Dakota Department of Health—South Dakota Cancer Registry, Retrieved from: https://www.cdc.gov/cancer/dcpc/prevention/screening.htm  
  2. Public Health Advocacy Institute of Northeastern University School of Law. (n.d.). Paid Leave – A Benefit for Employers and Employees. Retrieved from: http://www.tobaccopolicycenter.org/documents/Paid%20Leave-benefit%20for%20employee%20and%20employer%20FS%20UPDATED.pdf  
  3. The Community Guide, Cancer Screening: Client Reminders—Cervical Cancer. Retrieved from: https://www.thecommunityguide.org/findings/cancer-screening-client-reminders-cervical-cancer