Uninsured and Medicaid Patients Diagnosed with More Advanced Colorectal Cancer

An analysis of data from people diagnosed with colorectal cancer shows that those who are uninsured or covered by Medicaid are more likely to be diagnosed with a more advanced stage of colorectal cancer than those with private insurance or Medicare. Stage is a way of describing a cancer. The chance of successful treatment is better when cancer is diagnosed at an earlier stage (such as stage I) than a more advanced stage (stage III and IV).

The study, by the American Cancer Society (ACS), used the National Cancer Database (NCDB) to analyze data from 493,419 people diagnosed with colorectal cancer between 1998 and 2004. The NCDB is a registry sponsored by ACS and the American College of Surgeons that includes about 70% of people diagnosed with cancer in the United States. Insurance coverage for the patients used in the analysis was similar to the overall U.S. population, with approximately 63% covered by Medicare, 32% covered by private insurance, 2% covered by Medicaid, and 2% uninsured.

The results showed that people not covered by health insurance were nearly twice as likely to be diagnosed with stage II colorectal cancer than stage I cancer, compared with people covered by private insurance or Medicare, and twice as likely to be diagnosed with stage III or IV colorectal cancer than those with private insurance or Medicare. For people covered by Medicaid, the likelihood of being diagnosed with a more advanced stage of colorectal cancer was 1.4 times greater for stage II and 1.5 times greater for stage III or IV, when compared with people covered by private insurance or Medicare.

Previous smaller studies have shown a similar connection between insurance and cancer diagnosis, and other studies have shown that having Medicaid is associated with barriers to care, including longer waits for appointments and doctors who do not accept Medicaid patients.

"This study underscores the importance of having adequate insurance coverage. Access to care increases the likelihood of detecting colorectal cancer at an earlier stage. At the same time, we need to develop colorectal cancer screening programs for people who have no insurance or come from low-income households," said Michael T. Halpern, MD, PhD, Strategic Director of Health Services Research at ACS and the study’s lead author.

What this means for patients

Lack of insurance or limited insurance is a barrier for many patients. It is important for patients to talk with a doctor about colorectal cancer screening, including what tests are covered by their health insurance, and the names of organizations that may be able to provide free or low-cost colorectal cancer screening. Regular screening can often detect colorectal cancer earlier when there is a better chance of successful treatment.