The study released this week by the American Cancer Society highlighted the significant role health insurance plays in the widening chasm of disparities in breast cancer mortality.
Progress on this front has been made. The Affordable Care Act (ACA) has resulted in the lowest uninsured rate ever recorded in our nation’s history: 8.8% down from 16% in 2009 before the ACA was signed into law, according to the Council for Economic Advisers and National Center for Health Statistics. It has provided life-saving preventive and diagnostic screenings, access to higher quality care and appropriate treatments, as well as increased opportunities for diverse women to participate in clinical trials.
As we recognize National Breast Cancer Awareness Month this month and continue the national debate over health reform, it is worth noting the impact that a lack of health insurance coverage has on women reaching their optimal level of health or health equity.
I began my medical career as an obstetrics and gynecology resident in the late 1980s at Atlanta’s Grady Memorial Hospital. Emergency rooms in hospitals such as Grady were a last resort for uninsured patients who, in many cases, struggled with undiagnosed cancer, high-risk pregnancies, heart disease, diabetes and other life-threatening diseases.
The disparities in coverage and access to quality care for patients whose cards were stacked against them were striking, especially for women battling breast cancer, which is the most common cancer among women in the United States and is the second leading cause of cancer deaths.
While a host of factors increase women’s risk for breast cancer, such as genetics, age, sex and race, studies show that these factors are exacerbated for underserved communities, black women in particular, where the disease can be a catastrophic difference between life and death.
Mammogram screening is universally accepted as the best weapon for early breast cancer detection. Covered by the ACA as a preventive service at no cost to the consumer, mammogram screenings are the first line of defense. With the elimination of cost we expected an increase in mammograms, particularly among minority women. We hoped it would lead to a decrease in racial/ethnic disparities in breast cancer. And now many studies have confirmed the ethnic gap narrowed between women who received screening prior to ACA, and after.
Why does this matter? If we know that early detection is the key to lowering breast cancer mortality rates among all women, then access to appropriate screenings, early treatment and counseling should be considered the standard of care.
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