More cancers diagnosed at early
stage following increase in health insurance coverage
American Society of
Clinical Oncology (ASCO)
Cancer is most curable
when it’s detected at its earliest stages. An analysis of nearly 273,000
patients showed that between 2013 and 2014 there was a 1% increase in the
percentage of breast, lung, and colorectal cancers diagnosed at the earliest,
most treatable stage.
Following full implementation of the Affordable Care Act
(ACA), this study is the first to explore changes in the proportion of cancers
– those that can be detected through screening – diagnosed at stage I.
"Cancer is most
curable when it's detected at its earliest stages. While it is much too soon to
identify the specific cause of this positive trend, or determine whether it is
sustainable and will improve outcomes, it is indeed a step in the right
direction," said ASCO President-Elect Bruce E. Johnson, MD, FASCO.
Considering the
thousands of people diagnosed with these cancers annually, a 1% increase in
early-stage diagnosis could add up to a significant number of new cases and
potentially lead to better outcomes.
Following full
implementation of the Affordable Care Act (ACA), this study is the first to
explore changes in the proportion of cancers -- those that can be detected
through screening -- diagnosed at stage I.
The ACA has had a
measurable impact on increasing the number of people with health insurance in
the United States. The findings will be presented at the upcoming 2017 ASCO
Annual Meeting in Chicago.
"We know from
previous research that lack of insurance typically results in diagnosis of
cancer at a later, and usually less treatable, stage," said lead study
author Xuesong Han, PhD, Strategic Director, Health Policy and Healthcare
Delivery Research, American Cancer Society.
"Although we only
analyzed data from a limited timeframe, the fact that there appears to be a
positive trend in diagnosis at an earlier stage in multiple cancers is an
encouraging sign."
About the Study
The five types of
cancers analyzed in this study have screening methods that allow for detection
at an early stage, though in some instances, debate remains over efficacy and
appropriate use: mammography for breast cancer, colonoscopy for colorectal cancer,
Pap smear and/or HPV test for cervical cancer, spiral computed tomography or CT
for lung cancer, and PSA test for prostate cancer.
In this study,
researchers from the American Cancer Society used the National Cancer Database,
a registry of cancer cases reported by hospitals across the United States,
which captures about 70% of newly diagnosed cancer cases each year.
They focused on
patients under 65 years of age who were eligible for cancer screening and
diagnosed in 2013 or 2014. As the ACA was implemented in late 2013, the
researchers used the first nine months of 2013 as a baseline and compared
trends in cancer stage at diagnosis in this period to those in the last nine
months of 2014.
Key Findings: Researchers found a 1% increase in stage I
diagnoses for four of the five cancers detectable by screening: breast (from
47.8% to 48.9%) and cervical cancer (47.3% vs. 48.8%, although this difference
was not statistically significant) in women, and lung (from 16.6% to 17.7%) and
colorectal cancer (22.8% vs. 23.7%) in men and women.
The exception was
prostate cancer for which the percentage of stage I diagnoses fell by 1% (from
18.5% vs. 17.2%).
More research is
needed to see if this shift in stage at diagnosis is a short-term effect or
continues over time.
Next Steps
The researchers plan
to follow cancer diagnosis trends over the coming years. They also plan to look
beyond these five cancers and examine patterns in population databases that are
more generalizable.
