Media Issue Brief: Disparities in Cancer

October 11, 2017

ASCO’s Media Issue Briefs provide succinct overviews and relevant data on major policy issues impacting patients with cancer and the physicians who care for them. These briefs are designed to be especially helpful for journalists, offering background information on key issues across health policy today. Access ASCO’s full collection of Media Issue Briefs.

Issue Overview

Significant advances have occurred in the screening, diagnosis, and treatment of cancer. The benefits of this progress, however, are not universally available to everyone in the United States. The National Cancer Institute defines cancer health disparities as “adverse differences in cancer incidence (new cases), cancer prevalence (all existing cases), morbidity (cancer-related health complications), cancer mortality (deaths), cancer survivorship, and burden of cancer or related health conditions that exist among specific population groups in the United States.”1

Multiple factors contribute to disparities in cancer care, with significant inequities in cancer outcomes occurring particularly among the uninsured, Medicaid beneficiaries, and racial and ethnic minorities.

Key Data Points

Differences Between Those With and Without Health Insurance

In general, uninsured individuals are not as healthy as those with private coverage, and they are at higher risk for preventable hospitalizations and missed diagnoses of serious health conditions. They also have significantly higher mortality rates than those with insurance. For chronic conditions, they are less likely to receive follow-up care, which can delay the detection of certain cancers.2

  • In 2009, 50 million people in the United States were uninsured. By 2014, that number had dropped to 32 million, following the implementation of the Patient Protection and Affordable Care Act of 2010 (ACA), the major coverage provisions of which went into effect in January 2014.3
  • Minorities make up 55% of the uninsured population versus the 45% who are non-Hispanic Whites.
  • Hispanics and non-Hispanic Blacks have significantly higher uninsured rates (20.9% and 12.7%, respectively) than Whites (9.1%). The rate of uninsured is especially high for Hispanics, who are 19% of the total U.S. population but 34% of the uninsured population.4

Differences Between Individuals on Medicaid and Those With Other Health Insurance

As of September 2016, more than 73.1 million Americans were enrolled in Medicaid and the Children’s Health Insurance Plan (CHIP), which includes those added under the ACA expansion. At present, 19 states have not adopted Medicaid expansion under the ACA, effectively limiting access to cancer care for some Medicaid beneficiaries.5 Those who were enrolled in Medicaid before the ACA was enacted tend to have more limited benefits and greater restrictions on their care than beneficiaries who enrolled after ACA was enacted.

  • ACA provides for increased reimbursement under Medicaid for primary care services for a limited number of years and for bonus payments for primary care and major surgical services performed in Department of Health and Human Services-designated Health Professional Shortage Areas. These provisions do not apply to care for patients with cancer.6
  • Adult patients with cancer who are covered by Medicaid have poor clinical outcomes similar to those of uninsured patients.7 A 2015 study of cancer patients in California insured by Medi-Cal, the state’s health plan for low-income people, found patients are less likely to get recommended treatment and also have lower survival rates than patients with other types of insurance.8 The reason for these disparities is unclear.9

Minority Populations

Overwhelming evidence shows that racial and ethnic minorities with cancer experience disparities in incidence and mortality rates, although the reasons for these disparities are unclear. For example:

  • Among African American males, incidence and death rates are higher (12% and 27%, respectively) than Whites for all cancers combined and are higher for the most common cancers. In contrast, Black women have a 6% lower risk of a cancer diagnosis than Whites but a 14% higher risk of cancer death.10
  • Hispanics have lower rates of the most common cancers in the U.S. (female breast, colorectum, lung, and prostate) but among the highest rates of cancers associated with infectious agents. For example, compared to non-Hispanic Whites, cervical cancer incidence rates are 44% higher, and liver and stomach cancer incidence rates are about twice as high.11
  • Asian and Pacific Islanders (APIs) have the lowest overall cancer incidence and death rates but among the highest rates of liver and stomach cancers, about double those among non-Hispanic Whites: 20.6 and 14.5 incidents, respectively, per 100,000 people for API males versus 9.3 and 7.8 incidents per 100,000.12
  • Among American Indian/Alaska Natives, cancer is the leading cause of death followed by heart disease. In addition, this population’s death rates from lung cancer have shown little improvement, with the highest prevalence of tobacco use of any U.S. population.13
  • Native Hawaiians/Pacific Islanders are 30% more likely to be diagnosed with cancer, as compared to non-Hispanic whites.14 In Hawaii, Native Hawaiian men have the highest mortality rate for all types of cancer, as compared to other ethnic groups in the state, and Native Hawaiian women have the highest incidence rate for all types of cancer, as compared to other ethnic groups in the state.15

ASCO Addressing Disparities 

In 2009, the American Society of Clinical Oncology (ASCO) announced a major effort to integrate the elimination of cancer health disparities into the Society’s overall mission and issued a policy statement, “Disparities in Cancer Care.” Key components include raising awareness of disparities, improving access to care, and supporting research on health disparities.16

In 2011, ASCO issued a policy statement that examines disparities in cancer care and opportunities to reduce them through the Affordable Care Act, “Opportunities in the Patient Protection and Affordable Care Act to Reduce Cancer Care Disparities.” The statement’s recommendations include focusing efforts on community health centers, improving prevention and wellness care, and improving data collection.17

In November 2014, ASCO called for Medicaid reform in a policy statement that underscored the need to strengthen and expand access to high-quality cancer care for low-income Americans. The statement described problems that exist with the quality of care that Medicaid patients receive, such as a greater likelihood of being diagnosed with cancer at a later stage.18

In April 2017, ASCO issued a position statement that contained recommendations for reducing cancer health disparities among sexual and gender minority (SGM) populations, including individuals who are lesbian, gay, bisexual, transgender, and intersex. The recommendations were designed to focus attention on the challenges facing the SGM community—including discrimination and greater risk of anxiety and depression, resulting in disparate care—and concrete steps that can help minimize health disparities among SGM individuals.19

For More Information

  • ASCO policy statement regarding disparities in cancer care
  • ASCO policy statement regarding disparities in cancer care and the opportunities to reduce them through the Affordable Care Act
  • ASCO policy statement on the need for Medicaid reform
  • ASCO position statement on reducing cancer health disparities among sexual and gender minority populations
  • ASCO in Action offers the latest news and information on this and other cancer policy topics.
  • To schedule a media interview with an ASCO spokesperson or oncology expert, please contact mediateam@asco.org.

     
  1. National Cancer Institute. “Cancer Disparities.http://www.cancer.gov/about-nci/organization/crchd/about-health-disparities. Accessed Dec. 9, 2016.
  2. Ibid.
  3. The Henry J. Kaiser Family Foundation. The Kaiser Commission on Medicaid and the Uninsured. “Key Facts about the Uninsured Population.” http://kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/. Accessed on Dec. 9, 2016.
  4. Ibid.
  5. Centers for Medicare & Medicaid Services. “September 2016 Medicaid and CHIP Enrollment Data Highlights.” https://www.medicaid.gov/medicaid/programinformation/medicaid-and-chip-enrollment-data/report-highlights/index.html. Accessed Dec. 9, 2016.
  6. Journal of Clinical Oncology. “American Society of Clinical Oncology Policy Statement: Opportunities in the Patient Protection and Affordable Care Act to Reduce Cancer Care Disparities.” Oct. 1, 2011. http://ascopubs.org/doi/pdf/10.1200/JCO.2011.35.8903. Accessed on Dec. 9, 2016.
  7. Ibid. 
  8. University of California, Davis. “Disparities in Stage at Diagnosis, Survival, and Quality of Cancer Care in California by Source of Health Insurance.” https://www.ucdmc.ucdavis.edu/iphi/resources/1117737_CancerHI_100615.pdf. Accessed Dec. 9, 2016.
  9. Kaiser Health News. “Calif. Medicaid Patients With Cancer Fare Worse Than Those With Other Coveragehttp://khn.org/news/calif-medicaid-patients-withcancer-fare-worse-than-those-with-other-coverage/. Accessed Dec. 9, 2016.
  10. American Cancer Society. “Cancer Facts and Figures for African Americans 2016–2018.” http://www.cancer.org/acs/groups/content/@editorial/documents/document/acspc-047403.pdf. Accessed Dec. 9, 2016.
  11. American Cancer Society. “Cancer Facts and Figures 2016.http://www.cancer.org/research/cancerfactsstatistics/index. Accessed Dec. 9, 2016.
  12. Ibid.
  13. Centers for Disease Control. News Room: American Indian and Alaska Native death rates nearly 50 percent greater than those of non-Hispanic whites. http://www.cdc.gov/media/releases/2014/p0422-natamerican-deathrate.html. Accessed Dec. 9, 2016.
  14. U.S. Department of Health and Human Services Office of Minority Health. “Cancer and Native Hawaiians/Pacific Islanders.” http://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlID=76. Accessed Dec. 9, 2016.
  15. Hawaii Dept. of Health 2010. Hawaii Cancer Facts & Figures 2010. Table 5. http://health.hawaii.gov/about/files/2013/06/Hawaii_Cancer_Facts_and_Figures_2010.pdf. Accessed Dec. 9, 2016.
  16. Journal of Clinical Oncology. “American Society of Clinical Oncology Policy Statement: Disparities in Cancer Care.” http://jco.ascopubs.org/content/27/17/2881.full.pdf+html. Accessed on Dec. 9, 2016.
  17. Journal of Clinical Oncology. “American Society of Clinical Oncology Policy Statement: Opportunities in the Patient Protection and Affordable Care Act to Reduce Cancer Care Disparities.” Oct. 1, 2011. http://ascopubs.org/doi/pdf/10.1200/JCO.2011.35.8903. Accessed on Dec. 9, 2016.
  18. Ibid.
  19. Journal of Clinical Oncology. “American Society of Clinical Oncology Position Statement: Strategies for Reducing Cancer Health Disparities Among Sexual and Gender Minority Populations.” April 3, 2017.  https://www.asco.org/sites/new-www.asco.org/files/content-files/Strategi.... Accessed on Sept. 20, 2017.

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