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Uninsured women less likely to get cancer screening

NEW YORK (Reuters Health) – People without health insurance in rural areas are less likely to be up-to-date for routine health check-ups and cancer screening than those with coverage, according to a new study.

Cancer screening has been a contentious issue in recent years. Even by government-backed U.S. Preventative Services Task Force (USPSTF) standards, which some consider to be relatively conservative, screening rates for breast and cervical cancer were low in the study. Only about half of women in the Oregon-based research met USPSTF recommendations.

“People in rural areas tend to go to the doctor only when they are ill, so they don’t get the chance to talk about cancer screenings,” said Dr. Patricia Carney, a researcher at Oregon Health and Science University, Portland, who led the study.

Previous studies have shown that screening rates are lower among the uninsured, but that research has focused on people in towns and cities.

For the new study, partially funded by the American Cancer Society (ACS), researchers analyzed a decade of medical charts at two private health practices and two federally funded public health centers in rural Oregon. The study included more than 3,000 men and women, all at least 55 years old when the study began.

About 10% of participants lacked insurance coverage. Those with coverage had either private insurance, or a combination of private insurance, Medicare and Medicaid. The insurance status of about 16% of patients was unknown.

According to the report online May 30th in the journal Cancer, people with private insurance were much more likely to be up-to-date for some ACS recommended cancer screenings than people without insurance.

ACS mammography guidelines (which recommend mammograms starting at age 40) went unmet by 56% of women with insurance, compared to 78% of uninsured women, and 70% of those with Medicare or Medicaid.

When the findings were adjusted to reflect USPSTF guidelines, which recommend mammograms every other year starting at 50, the likelihood of women overall not being up to date for breast and cervical cancer screening fell from 70% to 48%.

For colon cancer screening, 58% of women with private insurance did not meet ACS guidelines — which recommend screening starting at the age of 50, just as the USPSTF does — compared to 87% of women without coverage, and about 57% of those with Medicare or Medicaid.

About half of insured men were not up-to-date for colon cancer screening, compared to almost 90% of uninsured men, but the difference was not statistically significant.

“The truth is, the people with insurance had appallingly low screening rates, too,” said Dr. Alfred Neugut, an epidemiologist and oncologist from Columbia University in New York, who wasn’t part of the study team.

Dr. Carney and Dr. Neugut agreed that there are likely many reasons why screening rates are low, from distances to the nearest health center to lack of interest in health care. But in the new study, cancer screening seemed to be linked to annual health visits.

“If you have insurance of any kind, you are more likely to go for a health visit, and if you have a health visit, you’re more likely to be up to date for cancer screening,” said Dr. Carney.

Even so, researchers found very low rates of health check-ups among the people they surveyed: more than half hadn’t been for a check-up in the last two years.

For Dr. Carney, the message is clear: more health insurance means more health visits and more screening, and the Affordable Care Act could lead to improvements. Later this month, the Supreme Court will rule on the act, which eliminates the need to pay a deductible, co-pay or coinsurance for preventative cancer screening.

“If the healthcare act is implemented, it could really change people’s ability to get cancer screenings…They would not be influenced anymore by all these out of pocket costs,” said Dr. Carney.


Cancer 2012.