Study Finds Cancer Diagnosis Linked to Insurance in USA

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Study Finds Cancer Diagnosis Linked to Insurance

By KEVIN SACK Published: February 18, 2008

ATLANTA — A nationwide study has found that the uninsured and those

covered by Medicaid are more likely than those with private insurance

to receive a diagnosis of cancer in late stages, often diminishing

their chances of survival.

The study by researchers with the American Cancer Society also found

that blacks had a higher risk of late diagnosis, even after accounting

for their disproportionately high rates of being uninsured and

underinsured. The study's authors speculated that the disparity might

be caused by a lack of health literacy and an inadequate supply of

providers in minority communities. The study is to be published online

Monday in The Lancet Oncology.

Previous studies have shown a correlation between insurance status and

the stage of diagnosis for particular cancers. The new research is the

first to examine a dozen major cancer types and to do so nationally

with the most current data. It mined the National Cancer Data Base,

which began collecting information about insurance in the late 1990s,

to analyze 3.7 million patients who received diagnoses from 1998 to 2004.

The widest disparities were noted in cancers that could be detected

early through standard screening or assessment of symptoms, like

breast cancer, lung cancer, colon cancer and melanoma. For each,

uninsured patients were two to three times more likely to be diagnosed

in Stage III or Stage IV rather than Stage I. Smaller disparities were

found for non-Hodgkins lymphoma and cancers of the bladder, kidney,

prostate, thyroid, uterus, ovary and pancreas.

When comparing blacks to whites, the disparities in late-stage

diagnosis were statistically significant for 10 of the 12 cancers.

Hispanics also had a higher risk but less so than blacks.

The study's authors concluded 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. "

Advanced-stage diagnosis, they wrote, " leads to increased morbidity,

decreased quality of life and survival and, often, increased costs. "

The study cites previous research that shows patients receiving a

diagnosis of colon cancer in Stage I have a five-year survival rate of

93 percent, compared with 44 percent at Stage III and 8 percent at

Stage IV.

" There's evidence that not having insurance increases suffering, " said

Dr. Otis W. Brawley, the American Cancer Society's chief medical officer.

Not all cancer researchers believe that comprehensive screening and

early detection is universally constructive. They argue that with

certain cancers, like melanoma and prostate cancer, it can lead to

misdiagnosis and overdiagnosis, with doctors identifying and treating

tumors that may never cause serious problems. In some of those cases,

surgery and drug therapies may actually shorten lives.

" Do these findings mean that patients without insurance are being

diagnosed too late, or that insured patients are being excessively

diagnosed? " said Dr. H. Gilbert Welch, a professor at Dartmouth who

studies the usefulness of medical procedures. " And if it does mean

that too many are being diagnosed late, we don't know if it's the

problem of not being insured or a problem of cultural norms and

patient education. "

Dr. Brawley said that the cancer society, the largest and wealthiest

of the disease-centered philanthropies, received no more than 5

percent of its $1 billion in revenues from corporate donations,

including some from medical suppliers and drug-makers that stood to

profit from expanded screening. He said the group had rejected

contributions from companies it considered directly connected to its

research, and that he saw no conflict in the study on cancer and

insurance.

The cancer society, Dr. Brawley said, has been conservative in its

screening recommendations, which vary by cancer type and age. The

study's results, he said, would encourage broader screening for

breast, colon and cervical cancers, where early detection has reduced

death rates, but not necessarily for other cancers.

http://www.nytimes.com/2008/02/18/health/18cancer.html