Making Cancer Screening Pay Off for You

The uninsured and Medicaid recipients are more likely to forgo tests and get late cancer diagnoses.

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Cancer screening is no fun, and every year around the time of my annual mammogram my emotions follow a now predictable path. For the week or so beforehand, I'm petrified at odd moments, sure that my good luck has run out. Then there's the inevitable unpleasantness of the exam itself—enough said about THAT—followed by relief that I've cheated cancer one more time. This lasts about two days, at which point low-level worry sets in again.

With all the emotional anxiety that accompanies these tests, is it any wonder that people avoid them if they can come up with an excuse? Lacking health insurance—as 47 million Americans do—may seem like a passable justification. So might being on Medicaid and having access to few providers who will take your coverage. But a new study by the American Cancer Society makes the case for screening even under challenging circumstances.

The study, published online yesterday in the Lancet Oncology, found that people without insurance and those on Medicaid were significantly more likely to be diagnosed with advanced-stage cancer (stage III or IV) than those with private insurance. This was especially true for cancers that are more easily detected through screening, like breast, colorectal, melanoma, and lung cancer. Regardless of insurance status, blacks and Hispanics were also found to have a higher risk of being diagnosed with late-stage cancer.

Other studies have examined the relationship between insurance status and cancer prevention and screening, but this study is both larger and broader than previous analyses, says lead author Michael Halpern, the strategic director for health service research for the American Cancer Society. The study examined a national sample of 3.7 million adults across the United States, tracking diagnoses between 1998 and 2004 for a dozen types of cancer.

"The magnitude surprised me," says Halpern. "The risk of late-stage diagnosis was two and sometimes three times greater for the uninsured and Medicaid recipients."

Play it safe. Don't let lack of money stop you from getting recommended screenings. Some organizations provide cancer screenings either free or for a minimal charge. The CDC's National Breast and Cervical Cancer Early Detection Program offers free or low-cost mammograms and Pap tests to low-income, uninsured, and underinsured women. Find a local program at or call 1-(800)-CDC-INFO. The American Cancer Society's call center (800-ACS-2345) may have information about screening programs in your area, and the Patient Advocate Foundation (800-532-5274) is another good resource for finding cancer screening programs for people who may not have access through their insurance.