Uninsured or Poorly Insured Patients Diagnosed at a Later Stage of Breast Cancer
Many of you may have read Natalia Hernandez's recent post about Medicaid dropping her insurance coverage in the middle of radiation treatment for Stage 4 breast cancer. For several months, Natalia has been writing for MyBreastCancerNetwork.com about her breast cancer treatment experience, from the perspective of a 27-year-old who was diagnosed with late-stage cancer.
I recently came across a news report from the New York Times ("Study Links Diagnosis of Cancer with Insurance," February 18, 2008) saying that the uninsured and women covered by Medicaid are more likely to be diagnosed with breast cancer at later, more advanced stages than those women with good insurance.
Is It Easier to Ignore a Breast Lump or Other Symptoms of Breast Cancer If You're Uninsured?
The American Cancer Society conducted the study by "mining" a database of 3.7 million patients diagnosed with cancer from 1998 to 2004. The sobering conclusion was one of great disparities: poorly insured patients were more likely to be diagnosed with several cancer types (especially those that could otherwise be detected early, such as breast cancer, lung cancer, colon cancer, and melanoma) at a later stage than the well -insured.
The news article also included comments from Dr. Otis Brawley, now the Chief Medical Officer of the American Cancer Society, indicating that some patients with a possible cancer symptom (e.g. a breast lump, a cough that might indicate lung cancer) delayed seeking care because of their lack of insurance. And Dr. Gilbert Welch's comments raised a few contrary points. But, overall it's a very disappointing study.
A Medical Oncologist's Perspective on Delayed Breast Cancer Diagnosis
Not having read the study I can't comment too much on it except to say I believe it, and I see it. In our office in San Francisco, we currently treat patients regardless of insurance type, and the Medi-Cal patients do seem to have a delay in diagnosis which anecdotally seems to be due to lack of insurance. Once they get to our office there are other hurdles they face - co-pays for medicines, transportation problems to and from the office, a more complex social milieu at home. Still, most of them persevere and get through their therapy appropriately. We have a particularly dedicated breast surgeon in town who helps these patients negotiate the system.
But, there is much work to be done, and as of now the future does not look particularly bright. Many doctors cannot afford to take Medi-Cal patients, and some can no longer afford to accept Medicare. In California the Medi-Cal budget will likely be cut due to budget deficits, at a time when it is already vastly underfunded, so I'm not optimistic things will get better.
Some doctors are moving away from accepting insurance all together to form "concierge" practices, a practice that is becoming more commonplace For those of us counting on Medicare as our health insurance in the future, it's important to worry about its future viability now.
It's an interesting time - we have more and more advances in diagnostics, therapeutics, and the potential for higher and higher cure rates. But there are problems with how best to deliver this care - problems that are not going away.