A study published last month in the Journal of the American Medical Association highlights and explores a significant racial disparity in breast cancer survival rates: the median survival time for black women after a breast cancer diagnosis is nearly three years shorter than it is for white women. What accounts for this striking disparity?
The researchers found poorer health, more comorbid conditions and more advanced disease at the time of breast cancer diagnosis to be the primary factors contributing to the difference in survival time between black and white women. In the 18 to six months prior to diagnosis, black women in the study were less likely to have had at least one primary care visit, and had significantly lower rates of breast cancer screening, colon cancer screenings and cholesterol screenings. In other words, white women appear to be surviving longer after a diagnosis of breast cancer in large part because they are receiving primary and preventive care earlier.
This month, we reach an important milestone in addressing disparities attributable to a lack of regular screenings, diagnostic tests and other preventive health care. August marks the one year anniversary of the implementation of the Affordable Care Act’s (ACA) requirement that most health insurance plans cover a critical array of women’s preventive health services without cost-sharing (copayments or deductibles). These benefits supplement other preventive health services required without cost-sharing under ACA provisions that went into effect in 2010. In the last two years, 71 million individuals with private health insurance benefited from these requirements. And just last month, the federal government finalized regulations confirming that millions of low-income individuals gaining coverage through the ACA’s Medicaid expansion will receive these same preventive health benefits at no charge to them.
Some of the more than 50 benefits included in these requirements are the very screenings and tests that lead to earlier diagnosis of breast cancer and better survival rates — services like mammograms, genetic testing (known as BRCA testing), counseling about medications that reduce breast cancer risk for women at high risk of developing the disease, and well-woman visits that include breast exams. Because some of these services can cost thousands of dollars, the coverage requirements will make them accessible for the first time for many of the women that need them.
While we know that many structural barriers and social factors contribute to and exacerbate health disparities, coverage of preventive health care without cost-sharing is a huge step toward ensuring that all of us have meaningful access to the services that we need to stay healthy and detect disease early. With enough public education about these benefits and with insurers providing them as required by the ACA, we are hopeful that disparities associated with preventable and chronic conditions will be reduced in the years to come.
This information was developed by Erin Armstrong, staff attorney at the National Health Law Program.
The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state. The views expressed in this post do not represent those of the Robert Wood Johnson Foundation.