Amy Chen, M.D. of the American Cancer Society and co-investigators found that the strongest predictors of advanced disease were health insurance status and type. Compared to patients with private insurance, patients with no insurance were the most likely to be diagnosed with advanced disease, the largest tumours or invasive disease to regional lymph nodes.
Patients with public health insurance, particularly Medicaid for low-income families, were also at higher risk for advanced disease, largest tumours, or lymph node involvement. Other factors were associated with more advanced disease at diagnosis, including gender (men were at higher risk), age (younger patients were at higher risk), and treatment facility type (patients who were treated at teaching or research facilities were at higher risk). However, type of health insurance remained the strongest predictor of stage at diagnosis and tumour size.
In their study of breast cancer and insurance status, Michael Halpern, M.D., Ph.D. and co-investigators found that uninsured and Medicaid insured patients were almost two and a half times more likely to be diagnosed with advanced disease than those with private insurance. In addition, they found African American and Hispanic patients were significantly more likely than white patients to be diagnosed at a more advanced stage. The authors say several factors probably contribute to the increased risk of disease among the uninsured and Medicaid populations, including fewer sources of regular medical care in general and less use of regular mammography in particular.
In both studies, health insurance strongly predicted disease severity. Authors from both studies recommend increasing access to healthcare and targeting screening programs specifically for the uninsured or underinsured to ameliorate this modifiable prognostic factor in these cancers.
MEDICA.de; Source: John Wiley & Sons