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Insurance Status Contributes to Racial Disparities in Breast Cancer

Doctor viewing mammogram.

A new study reports that a lack of adequate health insurance is responsible for nearly half of racial and ethnic disparities in breast cancer stage at diagnosis.

Earlier detection and treatment of breast cancer can significantly improve outcomes for patients diagnosed with this disease. However, studies have shown that a higher proportion of women of racial and ethnic minorities present with breast cancer at more advanced stages, negatively impacting their treatment and prognosis. In a study now published in JAMA Oncology, a team of researchers led by Naomi Y. Ko, MD, MPH, AM, Assistant Professor of Hematology and Medical Oncology at Boston University School of Medicine, investigated the association between health insurance status and stage at diagnosis in patients with breast cancer.

Using data from the Surveillance, Epidemiology, and End Results (SEER) database, Dr. Ko and colleagues analyzed the records of 177,075 women with breast cancer, including 148,124 patients who had health insurance coverage and 28,951 who were uninsured or receiving Medicaid. The patients were between 40 and 64 years of age and were diagnosed with breast cancer between January 1, 2010, and December 31, 2016.

The investigators found that 20% of women who were uninsured or receiving Medicaid presented with stage III breast cancer, compared with 11% of women with adequate health insurance. Hispanic, non-Hispanic black, American Indian, and Alaskan Native women also had an increased risk of being diagnosed with stage III breast cancer compared with non-Hispanic white women. Health insurance status was responsible for 45% to 47% of racial disparities in breast cancer stage at diagnosis.

"Compared with non-Hispanic white women, racial/ethnic minority women receive a diagnosis of breast cancer at a more advanced stage and have higher morbidity and mortality with breast cancer diagnosis," conclude Dr. Ko and colleagues in their publication. "This study's findings suggest that nearly half of the observed racial/ethnic disparities in higher stage at breast cancer diagnosis are mediated by health insurance coverage."

For More Information

Ko NY, Hong S, Winn RA & Calip GS, et al (2020). Association of insurance status and racial disparities with the detection of early-stage breast cancer. JAMA Oncol. [Epub ahead of print] DOI:10.1001/jamaoncol.2019.5672

Image credit: Bill Branson. Courtesy of the National Cancer Institute

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