September 19, 2008
The Costs of Cancer
PART ONE OF A TWO-PART SERIES
There aren’t any studies that prove that African Americans, when diagnosed with cancer, carry a larger percentage of the economic burden compared with white cancer patients. However, anecdotal evidence shows that they may pay higher out-of-pocket costs due to gaps in insurance coverage.
Some doctors believe that African Americans, who are often lower on the socio-economic ladder, are predisposed to be uninsured or underinsured. This means that oftentimes they go without treatment simply because they can’t afford insurance or even if they have insurance, they can’t afford the co-pays and deductibles. The Kaiser Family Foundation reports that the uninsured rate of non-elderly African Americans is 21% compared with 17% of the population overall.
The Reasons and Results of Late Diagnosis
An inability to afford treatment may not explain why black people have a higher incidence of some cancers, but it could be one of many reasons that African Americans have a higher rate of death from cancer.
According to the American Cancer Society, poor and uninsured people are more likely to be treated for cancer at late stages of disease, are more likely to receive substandard clinical care and services, and are more likely to die from cancer.
“African Americans who are privately insured will likely pay higher out-of-pocket costs for cancer treatment because they are more likely to be underinsured or insured by carriers that cover fewer procedures,” says Thomas A. LaVeist, Ph.D., director of the Hopkins Center for Health Disparities Solutions at the Johns Hopkins Bloomberg School of Public Health. “If you don’t have insurance that is generous in its coverage then the out-of-pocket costs might influence your decision-making [in terms of treatment].”
Lack of coverage might lead someone to forgo cancer screenings until later. Prolonged and postponed doctor’s visits usually mean diagnosis in later stages of cancer and poorer survival rates. Black people are more likely to be diagnosed with advanced stage diseases for breast, cervical, colorectal, lung, prostate, and ovarian cancers.
“If there is one thing that is both sad and morally unacceptable is that the advances we’ve made in cancer prevention, treatment, and control are directly related to early detection,” says Dr. Stephen B. Thomas director of the Center for Minority Health and a professor of the Community Health and Social Justice Graduate School of Public Health at the University of Pittsburgh. “African Americans are not taking advantage of early detection procedures. They are suffering the consequences of diseases that we now know how to prevent treat and control. And that’s a shame.”
Blacks are more likely to die from colorectal cancer than any other racial or ethnic group. “We know beyond a shadow of a doubt that colorectal cancer screening saves lives. The national recommendation is that you have a screening for colorectal at age 50,” says Dr. Thomas. “Despite those recommendations, not all insurances will pay for the cost of a colorectal cancer screening. That is why our health care system is so broken.”