Women from racial and ethnic minorities are more likely than non-Hispanic white women to be diagnosed with later-stage breast cancer. Black women in particular are more likely than white, Hispanic, or Asian women to be first diagnosed with a more advanced stage of breast cancer. Later discovery results in lower rates of survival, higher rates of complications, and lower quality of life.
Now, a new study offers a new window into one possible explanation for this disparity. Researchers publishing in JAMA Oncology in January found that almost half of this disparity could be explained by lack of insurance and access to care, offering an opportunity to improve outcomes.
“Insurance is a modifiable risk factor and having adequate health insurance for all could reduce the persistent racial outcome disparities in breast cancer,” wrote the authors, led by Dr. Naomi Y. Ko of Boston University School of Medicine.
The researchers looked at data from 177,075 women ages 40 to 64 diagnosed with stage I, II, or III breast cancer. The stages describe, in escalating order, tumor sizes and degree of spread to surrounding tissues. The current average five-year survival rate for stage 0 (not spreading to surrounding tissues) and stage I cancer is nearly 100 percent. For stage II, the rate is about 93 percent. The five-year survival rate for stage III is about 72 percent.
After analyzing the data, the researchers found that 20 percent of women who were either uninsured or using Medicaid received a stage III breast cancer diagnosis, compared with 11 percent of women who had health insurance. Non-Hispanic black women, American Indian or Alaskan Native women, and Hispanic women were all more likely than non-Hispanic white women to receive a stage III breast cancer diagnosis.
Between 45 and 47 percent of the racial differences in receiving the more advanced stage of diagnosis could be accounted for by health insurance status, according to the study.
“Adequate insurance coverage for all patients with cancer is an important consideration and one major systemic change that can be pursued to ameliorate consistent disparities,” the authors said, noting that many other factors influence disparities in breast cancer, including likely biological components. “Future studies should continue to examine the direct and indirect costs of inadequate health insurance to patients of all racial/ethnic backgrounds, their families, and society as a whole.”