Understanding the Condition of the U.S. Patient

The ACS has worked hard to draw an understanding of the effects of the high cost of health care and not having health insurance on the U.S. population. The National Cancer Database is sponsored by the American College of Surgeons Commission on Cancer and the ACS. The database covers approximately 70% of cancer patients treated in the U.S. Analysis of the data confirms that the uninsured are more likely to be diagnosed with advanced-stage, poor-prognosis disease.

Compared with those with private insurance, the uninsured are:

  • More than twice as likely to be diagnosed with advanced-stage breast cancer,
  • Nearly three times as likely to be diagnosed with advanced oropharyngeal cancer,
  • Four times as likely to be diagnosed with advanced laryngeal cancer [].

ACS intramural scientists have shown that insurance status matters even within stage at diagnosis. An insured American with Dukes B colon cancer has a higher likelihood of being alive 5 years after diagnosis than an uninsured American with Dukes A disease. Insurance coverage for all Americans is important if we are to reduce disparities [] (Fig. 1).

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Colorectal cancer patient survival versus insurance status. A Kaplan–Meier curve of colorectal cancer survival from time of diagnosis by stage and insurance status. Derived from National Cancer Database (NCDB), colorectal cancers diagnosed in 1999–2000.