Q&A: Inequities in Cancer Care

CURE, Spring 2012, Volume 11, Issue 1

Poverty as a carcinogen.

A: “Poverty is a carcinogen” were bold words when stated by Samuel Broder, MD, in 1991 when he was director of the National Cancer Institute. Today we have research that clearly demonstrates that if you are poor and uneducated, your chances of dying from cancer are significantly increased compared with someone who is better off economically and educationally.

In fact, when we look carefully at the numbers, the American Cancer Society estimates that in 2007 (the most recent year for which we have data) about 37 percent of the 164,000 deaths from cancer that occurred in people between the ages of 25 and 64 could have been averted if everyone had the same cancer death rates as the most educated whites. That is more than 60,000 people. Your education and your financial well-being— not the color of your skin—define your chances of finding a cancer early and getting proper treatment.

If the impact of education and economics is significant, don’t forget about the relationship of health insurance to survival from cancer.

Researchers have looked at the impact of insurance on stage of cancer at presentation and outcomes. Again, for several cancers, if you don’t have insurance, chances are your cancer will be diagnosed at a later stage, and your survival will be worse than people with insurance. For colon cancer in particular, uninsured folks with stage 1 cancer—the earliest stage—did worse than insured folks with more advanced stage 2 cancer.

We can’t ignore the fact that people who are disadvantaged educationally and economically simply have difficulty getting access to our healthcare system and, once in that system, have further difficulty receiving the care they need in a timely manner. It is incumbent upon all of us to be aware of the problems these cancer patients face and seek solutions that address the barriers to their care. None of us ask to get cancer, and all of us deserve medical care that gives us the best chance of making our journey through the cancer continuum a successful one.

—Len Lichtenfeld, MD, is deputy chief medical officer for the American Cancer Society. Send questions to editor@curetoday.com