Cancer Screening after the Adoption of Paid-Sick-Leave Mandates

N Engl J Med. 2023 Mar 2;388(9):824-832. doi: 10.1056/NEJMsa2209197.


Background: By the end of 2022, nearly 20 million workers in the United States have gained paid-sick-leave coverage from mandates that require employers to provide benefits to qualified workers, including paid time off for the use of preventive services. Although the lack of paid-sick-leave coverage may hinder access to preventive care, current evidence is insufficient to draw meaningful conclusions about its relationship to cancer screening.

Methods: We examined the association between paid-sick-leave mandates and screening for breast and colorectal cancers by comparing changes in 12- and 24-month rates of colorectal-cancer screening and mammography between workers residing in metropolitan statistical areas (MSAs) that have been affected by paid-sick-leave mandates (exposed MSAs) and workers residing in unexposed MSAs. The comparisons were conducted with the use of administrative medical-claims data for approximately 2 million private-sector employees from 2012 through 2019.

Results: Paid-sick-leave mandates were present in 61 MSAs in our sample. Screening rates were similar in the exposed and unexposed MSAs before mandate adoption. In the adjusted analysis, cancer-screening rates were higher among workers residing in exposed MSAs than among those in unexposed MSAs by 1.31 percentage points (95% confidence interval [CI], 0.28 to 2.34) for 12-month colorectal cancer screening, 1.56 percentage points (95% CI, 0.33 to 2.79) for 24-month colorectal cancer screening, 1.22 percentage points (95% CI, -0.20 to 2.64) for 12-month mammography, and 2.07 percentage points (95% CI, 0.15 to 3.99) for 24-month mammography.

Conclusions: In a sample of private-sector workers in the United States, cancer-screening rates were higher among those residing in MSAs exposed to paid-sick-leave mandates than among those residing in unexposed MSAs. Our results suggest that a lack of paid-sick-leave coverage presents a barrier to cancer screening. (Funded by the National Cancer Institute.).

MeSH terms

  • Breast Neoplasms* / diagnosis
  • Breast Neoplasms* / economics
  • Colorectal Neoplasms* / diagnosis
  • Colorectal Neoplasms* / economics
  • Early Detection of Cancer* / economics
  • Early Detection of Cancer* / statistics & numerical data
  • Health Services Accessibility / economics
  • Health Services Accessibility / legislation & jurisprudence
  • Health Services Accessibility / statistics & numerical data
  • Humans
  • Mammography / statistics & numerical data
  • Mandatory Programs / economics
  • Mandatory Programs / legislation & jurisprudence
  • Mandatory Programs / statistics & numerical data
  • Salaries and Fringe Benefits / economics
  • Salaries and Fringe Benefits / legislation & jurisprudence
  • Salaries and Fringe Benefits / statistics & numerical data
  • Sick Leave* / economics
  • Sick Leave* / legislation & jurisprudence
  • Sick Leave* / statistics & numerical data
  • United States / epidemiology
  • Urban Population / statistics & numerical data