Will More US Women Die of Breast Cancer with Healthcare Reform?

Three hundred thousand more women will die of breast cancer each year in the US if proposed health care reform takes place, according to a multi-million dollar television ad campaign running in several states this week.   The ads, sponsored by the Independent Women’s Forum, cite as evidence a report from Lancet Oncology that shows “England’s breast cancer survival rate is much lower than in the US.”

What’s the truth?  The truth is LESS women will die of breast cancer in the US if every woman has access to screening and treatment for breast cancer.  The American Cancer Society  looked at insurance status and cancer outcomes in 2005 and 2006.  Not surprisingly, only 38% of women between 40-64 years with no insurance had had a mammogram in the previous two years, compared to 75% of those with private insurance.  More importantly, patients with no insurance were more likely to be diagnosed with Stage III or Stage IV breast cancer, and less likely to be diagnosed with a Stage I cancer.

And survival from breast cancer?  The 5-year survival rate was 76% for all uninsured patients, and 65% for uninsured African American women, compared to 89% for White women with private insurance.  We may have some of the best breast cancer care available in the world, but unfortunately, it’s just not universally available to all US women.

Now back to the ad – what about this Lancet Oncology report they cite?  According to their website, they are referring to an article published in 2008, “Cancer Survival in five continents: a worldwide population-based study (CONCORD).”  The article gives 5-year survival rates for breast cancer – the US came in at 84%, compared to 70% for the UK.  What they left out in the ad were the 5-year survival rates in the article from several other countries that have universal health coverage: Sweden 82%, Canada 83%, Australia 81%, Japan 82% and Cuba 84%.

There has been a lot written about the differences between the datasets in England and the US, and differences in how the rates were obtained.  But the most important thing to know is that the UK rates are determined from a cancer registry that includes everyone.  The US rates are estimates, based on SEER data, which include about 10% of the population, and only those who access the healthcare system.

The other striking thing I noticed in digging around – England has made terrific strides in breast cancer care.  According to the latest registry figures, the 5-year survival rate for breast cancer is now just over 80% (the 70% figure was from early ’90s data).  Since 1989, breast cancer mortality has fallen by 36% in the UK.   They recognized a problem and took steps to correct it.  What strikes me, is how much more effective it must be to implement new public health initiatives in a country when you have consistent care and universal coverage.  To improve public health in our country, so much time and energy must be spent trying to reach those outside the heathcare system.   But that’s another day’s topic….

Every major breast cancer advocacy group in the US is calling for healthcare reform to improve breast cancer care in our country.  Shame on the IWF for using breast cancer to scare people away from healthcare reform.

*Thanks to my advocate friends, Liz here in the US, and Sara in the UK, for helping me find information for today’s blog.

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  • Ann Fonfa  On September 8, 2009 at 12:35 pm

    I think it is important to point out that survival has not been well connected (correlated) to ‘early’ detection. Mammograms find cancer when it is already there. The same % of late stage breast cancers are still being found as were found long ago. And there are harms related to undergoing mammograms annually – too many biopsies included.

    It is access to healthy foods, a healthier lifestyle, regular medical/dental attention, and the like, that keeps people well longer.

    Ann F.

  • Emily DeVoto  On September 13, 2009 at 2:55 pm

    Another thing to keep in mind – which Ann was alluding to – is that survival is not a surrogate for mortality. Survival is only valid when used in the context of a randomized trial. When reported at the national level (or, really, anywhere outside of a clinical trial), survival is highly subject to lead-time bias introduced by screening. There’s a great paper by Gil Welch et al. from JAMA that illustrates this well: http://www.ncbi.nlm.nih.gov/pubmed/10865276?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

  • Emily DeVoto  On September 13, 2009 at 2:56 pm

    Sorry, this url might work better: http://tinyurl.com/Welch-paper


  • Betty J. Hurtt-Nelson  On July 11, 2011 at 8:11 pm

    Ah, Politics. There is always money for that it seems.

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