Uninsured minorities should gain from Obama-style healthcare reform

A recent study suggests that by lowering access barriers to mammography, the Obama administration could help combat the tendency of uninsured minority women to delay seeking diagnosis for breast cancer. Delayed diagnosis translates into delayed treatment and a poorer prognosis for many women.

The study's investigative team was led by Dr. Cherie M. Kuzmiak, an assistant professor of radiology at the University of North Carolina at Chapel Hill, and included senior investigator Dr. Etta Pisano, a professor of radiology at the same institution.

Kuzmiak and colleagues retrospectively assessed a total of 617 women diagnosed with breast cancer. The investigators studied the correlation between the insurance status of these patients with the stage and size of tumors at the time of diagnosis. They found that uninsured, non-Caucasian patients have a higher probability of presenting with a more advanced stage of breast cancer and larger tumor size than patients with insurance. They published results in Academic Radiology (2008 Oct;15[10]:1255-8).

Of 617 patients in the study, 564 (91.4%) had insurance, 53 (8.6%) were uninsured; 447 (72.4%) were Caucasian, and 170 (27.6%) were non-Caucasian. Four hundred and thirty-three (93.5%) of the 463 patients with early-stage breast cancer (0, I, or II) had insurance, while 30 (6.5%) were uninsured. Of the 154 patients with late-stage breast cancer (III or IV), 131 (85.1%) had insurance and 23 (14.9%) patients were uninsured.

Uninsured patients had a 66% higher likelihood of presenting with a late-stage cancer and larger tumor compared with insured patients. A statistical analysis found a significant association between patients' cancer stage and insurance status (pp = 0.001). The same analysis also found non-Caucasians had a significantly higher risk of larger tumors and more advanced stage than Caucasians (p<0.005).

Mammographers have long suspected that non-Caucasian women are worse off when it comes to breast cancer diagnosis and that they tend to have more advanced cancers, said Dr. Wende Logan-Young, director and founder of the Elizabeth Wende Breast Clinic in Rochester, NY.

Although the study confirmed these suspicions, it does not provide further understanding of the relationship between ethnicity, insurance coverage, and breast cancer. Researchers should have compared the cancer status and tumor size of non-Caucasians without insurance with those of non-Caucasians who did have insurance, Logan-Young said.

"It would have been very interesting," Logan-Young said in an interview with Diagnostic Imaging. "Unfortunately, they didn't do that."

Many variables factor into the higher breast cancer incidence of non-Caucasians, particularly in black women who tend to have cancers that are more aggressive. Not having access to screening mammograms that are paid for by another party is something that does keep these patients from screening, Logan-Young said.

"Now that Barack Obama is to be sworn in as president, there will be an effort to provide insurance for Americans who are not insured now," Logan-Young said. "If that happens, that could make mammography eligible for everybody."

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