Privately insured diagnosed sooner

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 the late stages of the disease, 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. The authors speculated that the disparity might be caused by a lack of health literacy and a shortage of providers in minority communities.

The study is to be published online today 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 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, such as 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 bladder cancer, kidney cancer, prostate cancer, thyroid cancer, non-Hodgkins lymphoma, uterine cancer, ovarian cancer and pancreatic cancer; only for the last two were the disparities not statistically significant.

When comparing blacks with whites, the disparities in late-stage diagnosis were statistically significant for 10 of the 12 cancers. Hispanics had a higher relative risk as well, but less so than blacks.

The authors concluded that those without private insurance are not receiving the best screening, timely diagnosis or follow-up. Advanced-stage diagnosis, they wrote, "leads to increased morbidity, decreased quality of life and survival and, often, increased costs."

"There's evidence that not having insurance increases suffering," said Dr. Otis Brawley, the American Cancer Society's chief medical officer. He said some patients with possible cancer symptoms were delaying doctor's visits because they were uninsured.

Not all cancer researchers believe that comprehensive screening and early detection is universally constructive. They argue that with certain cancers it can lead to misdiagnosis and overdiagnosis.