Researchers from Canada have reported that breast cancer survival among poor Canadian women is significantly better than for poor women in the United States. These comparisons were published in an early online report on April 23, 2009 in the International Journal of Epidemiology[1] and in the January 2010 issue of the journal Health and Place.[2]

Unfortunately, underinsured or uninsured patients are reportedly at risk for impaired access to care, delays in medical treatment, and in some cases, substandard medical care. A recent article in the journal Cancer suggests that patients who are uninsured or those who receive Medicaid benefits may be at greater risk for developing postoperative complications and dying after surgery for colorectal cancer. Researchers from the Division of Cancer Prevention and Control and the Kentucky Cancer Registry have previously documented survival differences in patients with and without private health insurance. Researchers from the University of Pittsburgh have also reported that patients with “Medicaid/uninsured and Medicare disability were at increased risk of death after the diagnosis of squamous cell carcinoma of the head and neck when compared with patients with private insurance.”

The first Canadian study compared outcomes of poor women in the United States and in Canada who were diagnosed between 1994 and 2000 and followed until 2006. Low-income Canadian women had a 14% survival advantage over their U.S. counterparts. This difference was even greater for women under the age of 65 years, where the survival advantage of poor women in Canada was 21% greater than for poor women in the United States. For women with node-positive breast cancer, Canadian women had a 40% better survival. Canadian women with node-positive breast cancer had only a 12% improved survival compared with poor women in Hawaii, where the health care system is more comparable to Canada.

This author concluded: “More inclusive health care insurance coverage in Canada vs the USA, particularly among each country’s poor people, seems the most plausible explanation for such Canadian advantages. Provision of health care for all Americans would likely prevent countless early deaths, particularly among the relatively poor.”

The second study looked at a comparison between poor women in Ontario, Canada, and California. This study looked at women diagnosed with breast cancer between 1998 and 2000 and followed until 2006. They compared outcomes between extremely poor and affluent neighborhoods. These authors reported that poverty was associated with more non-localized disease and surgical and radiotherapy waits for poor women in California than in Ontario. They also found that poor women in California were less likely to receive breast-conserving surgery, radiation therapy, and hormonal therapy and had shorter survivals than women in Ontario.

Comments: These data clarify the impact of lack of insurance on outcomes of younger poor women with breast cancer with no or inadequate insurance compared with a country with universal health care. They also show that American women 65 years of age or older who are on Medicare do not have these same survival disparities with Canadian women.

References: