People With Private Health Insurance More Likely To Receive Early Cancer Diagnosis, Study Finds

Uninsured U.S. residents and Medicaid beneficiaries are more likely than people with private health insurance to be diagnosed with cancer in late stages, which reduces their chances for survival, according to a recent study by the American Cancer Society, the New York Times reports. The study was published online on Monday on The Lancet Oncology's Web site. For the study, researchers examined data from the National Cancer Data Base on 3.7 million people who were diagnosed with 12 types of cancer from 1998 to 2004.

The study found that among cancers that could be detected early through standard screening or assessment of symptoms -- such as breast cancer, lung cancer, colon cancer and melanoma -- uninsured patients were two to three times more likely than those with private coverage to be diagnosed in Stage III or Stage IV rather than Stage I. Smaller disparities were found in the diagnosis of non-Hodgkins lymphoma and cancers of the bladder, kidney, prostate, thyroid, uterus, ovary and pancreas.

The study's authors determined that "individuals without private insurance are not receiving optimum care in terms of cancer screening or timely diagnosis and follow-up with health care providers" and that advanced-stage diagnosis "leads to increased morbidity, decreased quality of life and survival and, often, increased costs."

Racial Disparities
The study also found that blacks have a higher risk of being diagnosed in later stages compared with whites, regardless of insurance status. The disparities in diagnoses for 10 of the 12 cancers examined were statistically significant for blacks when compared with whites. Hispanics also had higher risks than whites for later diagnoses, but not as high as blacks. The study's authors attributed racial disparities in cancer diagnoses to a lack of health literacy and an inadequate number of health care providers in minority communities (Sack, New York Times, 2/18).

Elizabeth Ward, director of surveillance research for ACS, said the racial disparities indicate that health insurance and access to care are "not the only" barriers to diagnosis and treatment.

Comments
Ward said the diagnosis disparity exists because insured people are more likely to receive regular screenings and physical examinations. She said, "If you're uninsured, you're about half as likely to get mammography and colonoscopy as if you're insured." She added that the study's results tell researchers "that the health care safety net is fairly thin." She said, "If you don't have health insurance, it's pretty difficult in some instances to find a source of medical care" (White, Atlanta Journal-Constitution, 2/18).

Michael Halpern, the study's lead author and an ACS researcher, said, "For cancers that can be detected early or show symptoms early, insurance makes a huge difference, a two- to three-fold difference, in terms of early diagnosis"(Human, Denver Post, 2/18).

Otis Brawley, ACS chief medical officer, said, "There's evidence that not having insurance increases suffering" (New York Times, 2/18). Brawley said, "Insurance versus non-insurance is a great marker for people who are socially deprived or poor," adding, "While giving people insurance would improve things, it will not improve everything" (Atlanta Journal-Constitution, 2/18).

An abstract of the study is available online.