Health care reform and prevention of cancer

In Sunday’s New York Times (story), Robert Pear wrote about the many disease prevention initiatives contained in the new health care law recently passed by congress and signed by the president. It’s important to stop and consider the full implications of this. 
Importantly, Medicaid will now cover drugs and counseling to help pregnant women stop smoking. This will have substantial public health benefit. Worksites allowing a reasonable break time for nursing mothers to either nurse of pump milk will not only be of benefit for the infant being breastfed but also for the mother, as longer durations of breastfeeding significantly reduce risk of ovarian cancer and breast cancer. This long term benefit to new mothers is often overlooked in policy debates.
Access to screening is also positioned as a benefit of the new law. Yet, we should not forget that access alone does not remove disparities in the cancer burden. Strong evidence from Medicare shows that with access to colon cancer screening in place, levels of screening have risen over time. Importantly this increase has been observed across race and education levels. However, significantly lower rates of screening for colorectal cancer are observed among less educated older adults. As of 2005 among Medicare beneficiaries, rates of colon cancer screening were 20 percent lower among those with a less-than-high school education compared to those with a greater-than-high school education (study link) (1). Similar disparities were observed by income level.  
The clear message is that we must continue to focus prevention messages and strategies on ways to reach such groups so they too can gain the benefits of cancer prevention through colorectal screening. We cannot ignore the powerful data that come from Medicare through the past decade. Prevention efforts must focus on strategies that bring participation in prevention to a common level across society. Only then will we achieve the benefits of wellness for all regardless of age, education and income.
For more on cancer prevention, see:
Literature cited
  1. Doubeni, C.A., et al., Socioeconomic and racial patterns of colorectal cancer screening among Medicare enrollees in 2000 to 2005. Cancer Epidemiol Biomarkers Prev, 2009. 18(8): p. 2170-5.

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