Lack of Insurance Tied to Later Stage of Breast Cancer at Diagnosis

Insurance status and access to care play an important role in racial disparities in stage of breast cancer at diagnosis, according to a study published online January in JAMA Oncology.

Naomi Y. Ko, M.D., from the Boston University School of Medicine, and colleagues used data from the Surveillance, Epidemiology, and End Results Program to identify 177,075 women (aged 40 to 64 years) diagnosed with stage I to III breast cancer from 2010 through 2016. Associations between insurance status (148,124 insured and 28,951 uninsured or receiving Medicaid) and breast cancer staging were assessed.

The researchers found that a greater proportion of women either receiving Medicaid or who were uninsured received a diagnosis of locally advanced breast cancer (stage III) versus women with health insurance (20 versus 11 percent). Non-Hispanic black (odds ratio [OR], 1.46; 95 percent confidence interval [CI], 1.40 to 1.53), American Indian or Alaskan Native (OR, 1.31; 95 percent CI, 1.07 to 1.61), and Hispanic (OR, 1.35; 95 percent CI, 1.30 to 1.42) women had higher odds of receiving a diagnosis of locally advanced disease (stage III) versus non-Hispanic white women. However, associations between race/ethnicity and risk for locally advanced breast cancer were attenuated when adjusting for health insurance and other socioeconomic factors (non-Hispanic black: OR, 1.29 [95 percent CI, 1.23 to 1.35]; American Indian or Alaskan Native: OR, 1.11 [95 percent CI, 0.91 to 1.35]; Hispanic: OR, 1.17 [95 percent CI, 1.12 to 1.22]). Health insurance mediated just under half (45 to 47 percent) of racial differences in the risk for locally advanced disease.

"Diagnosing breast cancer early is not only beneficial for individual patients and families, but also on society as a whole to decrease medical costs and promote equity among all populations," Ko said in a statement.

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