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People
with private health insurance more likely to
receive early Cancer Diagnosis
[Feb 19, 2008] 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 Database 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.
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