Advanced Cancers More Likely In The Uninsured And Ethnic Minorities

A large study of 12 types of cancer in over 3 and a half million American cancer patients has found that compared with patients on private medical insurance, patients who are uninsured or with Medicaid (the government programme for the poor), are significantly more likely to present with advanced stage cancer, as are black and Hispanic patients, compared with whites.

The study is published in the early online 18th February issue of The Lancet Oncology and is the work of researchers with the American Cancer Society, led by Dr Michael Halpern, strategic director of health services research.

This is the first large scale study to look at the connection between insurance status, ethnicity and stage of cancer diagnosis for a wide range of cancer types.

The researchers found that the strongest link between insurance status and advanced cancer stage was in those cancers that can be diagnosed at an early stage through effective screening or symptom evaluation.

The researchers used information from the National Cancer Database, which collects registered patient records from over 1,430 hospitals throughout the country and covers over 70 per cent of cancer patients in the US.

Halpern and colleagues analysed records for patients aged from 18 to 99 diagnosed with any of 12 cancers between 1998 and 2004.

The results showed that:

• The 3,742,407 cancer patients included in the analysis had similar characteristics to the rest of the US population that was not included.


• There were consistent patterns between insurance status and stage at diagnosis across all cancer types.


• Patients on Medicaid insurance or with no insurance were significantly more likely to be diagnosed with an advanced stage cancer compared with patients who had private insurance.


• This link was strongest for those cancers that have the potential to be detected at an early stage by screening or early assessment of symptoms, such as breast, lung, colorectal cancers and melanoma.


• The greatest chance of uninsured and Medicaid patients being diagnosed at stage II (moderately advanced cancer) instead of stage I was in colorectal cancer.


• The greatest chance of this group being diagnosed at the most advanced stage of cancer (III or IV) was in breast cancer.


• In contrast, for cancers that do not have the potential for early screening or diagnosis, such as ovarian and pancreatic, the chances of being diagnosed at more advanced stages were not significantly, or only marginally different, among privately insured, uninsured and Medicaid insured patients.


• Black and Hispanic patients appeared to have a higher risk of advanced-stage disease (stage III or IV) at diagnosis, regardless of insurance status, compared with White patients.

The authors concluded that:

"In this US-based analysis, uninsured and Medicaid-insured patients, and those from ethnic minorities, had substantially increased risks of presenting with advanced-stage cancers at diagnosis."

" Although many factors other than insurance status also affect the quality of care received, adequate insurance is a crucial factor for receiving appropriate cancer screening and timely access to medical care," they added.

The authors also pointed out that because some of the patients did not enroll for Medicaid until after their diagnosis, it could signal that lack of health insurance is a barrier to medical care, rather than being on Medicaid being indicative of untimely screening and diagnosis.

There are 47 million Americans without health insurance. John R Seffrin, chief executive officer for the American Cancer Society, said this study was a critical finding for this group:

"The fact is", said Seffrin, "Too many cancer patients are being diagnosed too late, when treatment is harder, more expensive, and has less chance of saving lives."

"We must begin to remove the barriers that stand in the way of early diagnosis and timely access to medical care if we are to give all cancer patients an equal chance in the fight," he urged.