US patients who are uninsured or have Medicaid insurance, and those from ethnic minorities, are significantly more likely to present with advanced cancer at diagnosis than privately insured patients, according to an article to be published in the March issue of The Lancet Oncology.

Importantly for these patients, the greatest risk of diagnosis at an advanced stage occurred for cancers that could potentially be detected early by routine screening or were symptomatic at early stages, say the authors.

The authors conclude that these findings have important implications for the US health-care system and policy decisions regarding health-care reform.

Cancer patients in the USA without private medical insurance are less likely to participate in cancer prevention and screening services or have access to timely diagnostic care and treatment. Furthermore, uninsured and Medicaid-insured patients are significantly more likely to be members of ethnic minority groups than non-Hispanic white people. Previous studies, using data from the early to mid 1990s from specific geographical regions (eg, single US states), have shown that uninsured and Medicaid-insured individuals have more advanced cancer† at diagnosis than privately insured patients. However, this finding has not been confirmed by use of contemporary or national-level data.

Therefore, Dr Michael Halpern (American Cancer Society, Atlanta, USA) and colleagues assessed the effect of insurance status and ethnicity on cancer stage at diagnosis for 12 common types of cancer in 3 742 407 patients diagnosed between 1998 and 2004, who were identified using the US National Cancer Data Base (NCDB).

The researchers found that uninsured and Medicaid-insured patients were significantly more likely to present with advanced-staged disease compared with privately insured patients. The authors noted that this finding was most prominent for patients who had colorectal and breast cancers that can potentially be detected early by routine screening or for those patients with melanoma or urinary bladder cancer that often present with symptoms at early stages. Furthermore, Black and Hispanic patients were noted to have an increased risk of advanced disease at diagnosis, irrespective of insurance status. According to the authors, this highlights other social and cultural barriers that: "also probably affect seeking care and the quality of patient-provider communication."

The authors conclude: "The findings from our analysis, in terms of Medicaid, suggest that simply providing health insurance without ensuring that this coverage is sufficient is unlikely to substantially increase the proportion of patients diagnosed at early stages. Changes in insurance coverage for the uninsured and underinsured need to consider the adequacy, availability, and affordability of new programmes."