Two new studies from the American Cancer Society strengthen the evidence of a connection between insurance status and the severity of some cancers at diagnosis.

In one, uninsured women or those with Medicaid coverage were nearly two and a half times more likely to be diagnosed with advanced breast cancer than those with private insurance. Halpern and colleagues analyzed data on 533,715 patients from nearly 1,500 hospitals nationwide. Those diagnosed with advanced breast cancer (stage III or IV) accounted for 8% of the privately insured, but 18% of the uninsured and 19% of Medicaid patients. Data analysis also showed that black and Hispanic women, regardless of insurance status, were more likely to have advanced-stage disease at diagnosis.

The second study, the first to assess the relationship between oropharyngeal cancer diagnosis and insurance status, also found that Medicaid patients and those without insurance "were at the greatest risk for presenting with advanced oropharyngeal cancer."

After a retrospective analysis of 40,487 patients, Chen and colleagues concluded that patients without insurance or with Medicaid coverage presented with advanced-stage disease, larger primary tumor size, and greater lymph node involvement more often than did those with private insurance, and that "insurance coverage appeared to be a highly modifiable predictor of cancer stage."

These studies reinforce findings that people with poor or no insurance coverage are less likely than those with private insurance to receive regular health care or preventive services, which could allow earlier diagnosis. "How much evidence do we need to tell that the health care system is not working for a huge population of people?" asked Pamela J. Haylock, former president of the Oncology Nursing Society.

Mary Hager