The Affordable Care Act has provided life-saving preventive and diagnostic screenings
Insurance coverage disparity is striking, especially for women battling breast cancer
Editor’s Note: Dr. Valerie Montgomery Rice is president and dean of Morehouse School of Medicine in Atlanta and an expert on women’s health equity.
The study released this week by the American Cancer Society highlighted the significant role health insurance plays in the widening chasm of disparities in breast cancer mortality.
Progress on this front has been made. The Affordable Care Act (ACA) has resulted in the lowest uninsured rate ever recorded in our nation’s history: 8.8% down from 16% in 2009 before the ACA was signed into law, according to the Council for Economic Advisers and National Center for Health Statistics. It has provided life-saving preventive and diagnostic screenings, access to higher quality care and appropriate treatments, as well as increased opportunities for diverse women to participate in clinical trials.
As we recognize National Breast Cancer Awareness Month this month and continue the national debate over health reform, it is worth noting the impact that a lack of health insurance coverage has on women reaching their optimal level of health or health equity.
I began my medical career as an obstetrics and gynecology resident in the late 1980s at Atlanta’s Grady Memorial Hospital. Emergency rooms in hospitals such as Grady were a last resort for uninsured patients who, in many cases, struggled with undiagnosed cancer, high-risk pregnancies, heart disease, diabetes and other life-threatening diseases.
The disparities in coverage and access to quality care for patients whose cards were stacked against them were striking, especially for women battling breast cancer, which is the most common cancer among women in the United States and is the second leading cause of cancer deaths.
While a host of factors increase women’s risk for breast cancer, such as genetics, age, sex and race, studies show that these factors are exacerbated for underserved communities, black women in particular, where the disease can be a catastrophic difference between life and death.
Mammogram screening is universally accepted as the best weapon for early breast cancer detection. Covered by the ACA as a preventive service at no cost to the consumer, mammogram screenings are the first line of defense. With the elimination of cost we expected an increase in mammograms, particularly among minority women. We hoped it would lead to a decrease in racial/ethnic disparities in breast cancer. And now many studies have confirmed the ethnic gap narrowed between women who received screening prior to ACA, and after.
Why does this matter? If we know that early detection is the key to lowering breast cancer mortality rates among all women, then access to appropriate screenings, early treatment and counseling should be considered the standard of care.
However, this is not the end of the story. There are differences in genetic mutations and tumor characteristics that lead to triple negative breast cancer, a more deadly form of breast cancer that does not respond to hormonal therapy or other targeted therapies. Black women are at higher risk, contributing to a higher mortality rate than white women.
This is an opportunity to expand research and testing to underserved communities to address disparities that continue to persist in breast cancer mortality rates. We need to ensure that diverse women are fully represented in clinical trials and studies that examine the most common hereditary cancers like breast cancer. With advances in medical technology and clinical-grade genetic testing, no woman should die of breast or ovarian cancer due to genetic mutations.
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As we continue to examine gaps in overall health and breast cancer mortality impacted by insurance access, we must look through a lens of equity and actively embrace policies that support healthy outcomes for our most vulnerable populations.