In this, the second in our month-long series on the disparities and inequities of cancer in the U.S. and beyond, we look at the millions of currently uninsured Americans and the burden they bear if they have the misfortune to develop the disease:
Simply, put, having health insurance can make all the difference when it comes to cancer. According to experts, if you are lucky enough to have health insurance, you:
• Are more likely to get screening tests, such as Pap tests and colonoscopies, which catch the disease in its early, more curable stages.
• Are more likely to be in good health generally and thus better able to fight cancer if it occurs.
• Are more likely to get to the doctor sooner when cancer symptoms first appear. Among uninsured people, the cancer is more likely to have spread by the time they see a doctor.
• Are more likely to get high-quality cancer treatments and benefit from state-of-the-art technology.
According to government statistics, the number of uninsured people in the United States has increased to more than 50 million. Minorities are more likely to be uninsured: A study of data from 2009 found that 34 percent of Hispanics, 23 percent of African-Americans, 28 percent of American Indians, and 18 percent of Asians didn’t have health coverage, compared to 14 percent of whites.
In 2008 the American Cancer Society found that uninsured cancer patients were more than twice as likely to die within five years compared to insured patients. This was the first national study of its kind to shine a light on the differences in cancer between who lived and who did not among the uninsured and insured.
"The truth is that our national reluctance to face these facts is condemning thousands of people to die from cancer each year," Dr. Elmer Huerta, director of the Cancer Preventorium at Washington Cancer Institute, MedStar Washington Hospital Center, said of the study, published in CA: A Cancer Journal for Clinicians.
"About 10 percent to 40 percent of disparities are related to being uninsured. But it depends to some extent on what type of cancer you're talking about," says Dr. David Wetter, a professor in the department of Health Disparities Research, Division of Cancer Prevention and Population Sciences, at the University of Texas MD Anderson Cancer Center, in Houston. "For lung cancer, access to care may be less important than colorectal cancer because 90 percent of all lung cancers are caused by smoking."
But, he adds, disparities can influence a disease like colorectal cancer a great deal. People who have insurance and access to care can undergo periodic colonoscopies that detect cancer in its earliest stages, when the disease is highly curable.
In the past, it's been tough to determine just how much cancer outcomes differ in the uninsured compared to the insured. Most death certificates don't state whether those who died were insured. However, other studies show that people who don’t have insurance face big barriers when it comes to cancer prevention and treatment. A Kaiser Family Foundation survey found that more than one in four uninsured patients delayed treatment or skipped treatment because of the cost.
Moreover, Wetter says, people without access to quality healthcare or who are uninsured or under-insured may also miss out on the best care that offers the best chance of survival.
For example, new screening tests that can tell someone if they have a particular genetic mutation can help doctors steer their patients to the most effective medications and treatments. But if you're uninsured, genetic testing is likely to be a luxury you simply can't afford. "Any time we have something new and great, it often exacerbates disparities," Wetter says. "Those who tend to have the most resources take advantage of those advances. If we are going to make sure that doesn't happen as we move into the new era of personalized medicine, we're really going to have to make special efforts to ensure we reach under-served populations that don't have the access to high technologies."
Public health officials hope that changes under the Affordable Care Act (ACA) will influence cancer statistics in years to come. Most Americans will qualify for healthcare under the ACA. In addition, most preventive health services, such as recommended cancer screening exams, will be free under the law.
Do you think death rates for cancer will fall in the coming years thanks to universal access to health coverage? What else would it take to solve these inequities?
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Shari Roan is an award-winning health writer based in Southern California. She is the author of three books on health and science subjects.