Lack of Health Insurance Linked to Later-Stage Cancer Presentation Interview with:

Dr. Christine Fisher MD, MPH Department of Radiation Oncology University of Denver

Dr. Christine Fisher

Dr. Christine Fisher MD, MPH
Department of Radiation Oncology
University of Denver What is the background for this study?

Dr. Fisher: Screenable cancers are treated by oncologists every day, including many in invasive, advanced, or metastatic settings.  We aimed to determine how health insurance status might play into this, with the hypothesis that better access to health care would lead to presentation of earlier cancers.  While this sounds intuitive, there is much debate over recent expansions in coverage through the Affordable Care Act and how this may impact health in our country. What are the main findings?

Dr. Fisher: The findings confirm that those without health insurance present with more advanced disease in breast, cervix, colorectal, and prostate cancers, including tumor stage, grade and elevated tumor markers.  That is to say, all else being equal for risk of cancer, lack of health insurance was an independent risk factor for advanced presentation. What should clinicians and patients take away from your report?

Dr. Fisher: The takeaways include an increased focus on screening and prevention for these cancers.  These techniques save lives and reduce the morbidity and mortality of advanced presentations.  Locally in Colorado, there are resources for patients in low income brackets without insurance to get screening for breast and cervical cancer through the Colorado Department of Public Health. What recommendations do you have for future research as a result of this study?

Dr. Fisher: Future research is very exciting in this area, which looks at how to increase uptake of screening, as well as turn opportunities for screening into prevention.   For instance, I am working with a few colleagues on how we can take the opportunity of mammograms for breast cancer screening to offer potential preventive approaches.  For cervical cancer, and a host of other HPV related tumors, increased utilization of the HPV vaccine will be critical to reduce future disease burden in this frequently young and health population. Is there anything else you would like to add?

Dr. Fisher: The promise of screening and prevention is to actually reduce the number of cancers, as well as those with advanced presentations of cancers, across the United States.  This is, without a doubt, an opportunity that oncologists, as well as primary care providers, must be excited about and look to advance.

I would like to thank my co-authors, and especially first author Arya Amini, for his ongoing interest and research in women’s health.


Public Health. 2016 Apr 15. pii: S0033-3506(16)00105-0. doi: 10.1016/j.puhe.2016.03.014. [Epub ahead of print]

Disparities in disease presentation in the four screenable cancers according to health insurance status.

Amini A1, Jones BL1, Yeh N1, Guntupalli SR2, Kavanagh BD1, Karam SD1, Fisher CM3.

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