For the Young and Uninsured, Cancer Diagnosis Often Comes Late

Adolescents and young adults who do not have health insurance are more likely than those who have private insurance to be diagnosed with cancer after it has spread to other parts of the body – when it is more deadly and harder to treat.

This finding is from a study by American Cancer Society researchers, published early online January 28 in the journal Cancer, and available in the March issue. The study included a national sample of people in the United States aged 15 to 39 who had been diagnosed with cancer between 2004 and 2010.

The researchers found that among males in this age group, the uninsured were one and one-half times more likely than the privately insured to be diagnosed with cancer that had spread. The outcome was worse for uninsured females, who were nearly twice as likely as their privately insured counterparts to get a distant-stage cancer diagnosis.

American Cancer Society researcher, Anthony Robbins, MD, Ph.D., lead author of the study, says the finding is important because those aged 15 to 39 are the most likely in the United States to lack health insurance.

The link between a lack of insurance and getting a distant-stage diagnosis was stronger for cancers that often can be found during routine medical visits because they may cause noticeable symptoms, such as melanoma, thyroid, and breast cancers. But that only works if patients receive regular care and have providers who know their medical history – an unlikely scenario for the uninsured.

The authors note that their study is unique because of the large sample size – nearly 260,000 adolescents and young adults – and because it is the first to assess all cancer sites for this population. Previous studies of older populations, including research conducted by the American Cancer Society, have similarly found that the uninsured are more likely to get diagnosed with cancer at a later stage and that the uninsured are less likely to survive a cancer diagnosis.

The new study suggests that increasing insurance rates among adolescents and young adults could help in the future to improve their survival rates. This is because stage of diagnosis and chances of survival are strongly linked – and neither metric has been improving in a major way for adolescents and young adults. Robbins says the 15- to 39-year-old age group “has seen only small gains in survival since the mid-1970s, compared to much larger survival gains among children and older adults.” The hypothesis is that insurance is a key factor here – children and older adults are much more likely than those aged 15 to 39 to have health insurance.

The good news, according to Robbins, is that “the Affordable Care Act (ACA), with its focus on increasing private insurance coverage of young adults aged 19 to 25 and providing certain cancer screenings at no cost to patients, has the potential to make a big impact on this age group.”

Robbins warns that because many states have not elected to broaden Medicaid eligibility under the ACA, the uninsured rate will not decline as much as originally expected – an outcome that he says will disproportionately impact the adolescent and young adult population, which is the age group most likely to be uninsured. Still, Robbins states that he hopes “the impact of the ACA will be large enough to turn around the long-term stagnation in survival rates these patients have experienced.”