Earlier Cancer Diagnoses Inside Military Health System Inspire Public Confidence

Photo By James Black | MHS Patients Receive Earlier Cancer Diagnoses Than General U.S. Population | Photo Credit: Department of Defense  

BETHESDA, MD, UNITED STATES

01.29.2024

Story by James Black 

Walter Reed National Military Medical Center

Cancer Research Collaboration Accelerates Diagnoses and Patient Options

Researchers at the Walter Reed National Military Medical Center, the Murtha Cancer Center Research Program, and the Uniformed Services University (USU) recently published a groundbreaking, collaborative study indicating that cancer patients treated within the Military Health System (MHS) generally received earlier cancer diagnoses than privately insured or Medicaid patients.

The "Cancer stage at diagnosis: Comparison of insurance status in SEER to the Department of Defense Cancer Registry" study, published in "Cancer Medicine," continues to spark conversation inside the cancer research community.

“Everything we do in MCCRP research involves collaborations and team science, as the complexity of analyzing huge Department of Defense (DOD) datasets and the statistical expertise involved is considerable,” shared retired U.S. Army Col. (Dr.) Craig Shriver, the director of the Murtha Cancer Center and a professor of surgery at USU.

Shriver also serves as director of the congressionally mandated Clinical Breast Cancer Project (CBCP), a military-civilian coalition providing excellent clinical care, cutting-edge breast cancer research, and an extensive biorepository of human breast cancers and tissue researchers worldwide use.

The Cancer Medicine study’s lead author, U.S. Navy Lt. James T. Flanary, spearheaded the study in partnership with Drs. Jie Lin, Shriver, and Kangmin Zhu.

MHS Patients Receive Earlier Cancer Diagnoses Than General U.S. Population

“Early detection of cancer results in decreased mortality, and in order for a malignancy to be detected and diagnosed, a person must have access to medical care,” the study outlined. “At present, the United States remains without a means in which to provide effective health care for its entire population.”

Study Populations

The study population included those who were 18 years or older with a first cancer of the invasive lung, prostate, breast, or colon, histologically diagnosed between Jan. 1, 2007, and Dec. 31, 2013. According to the authors, these four cancers were the most common in terms of incidence and mortality during that period.

Murtha Cancer Center Research Program: Increasing Resilience and Readiness

Part of MCCRP’s mission is to detect and treat cancer as a readiness issue for the active-duty force, shared Shriver, whose family, friends, and colleagues’ lives have been touched by colon cancer.

“Colon cancer is one of the few cancers that has very effective screening, which also can lead to the prevention of colon cancer by the removal of small non-cancerous polyps before they become cancerous,” explained Shriver, encouraging stakeholders to undergo regular colon cancer screenings no later than age 45.

MHS Universal Care vs Private Health Care and Medicaid

“The MHS provides universal health care to its beneficiaries,” the authors noted. “Our previous studies showed that MHS beneficiaries had earlier stages of colon, breast and lung cancers compared to the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) registry. However, these studies did not subdivide the SEER population by insurance status category. Comparison of each insurance status to the MHS can offer more nuanced evidence of its association with stage at diagnosis,” the authors explained.

According to the researchers, MHS patients were diagnosed at an earlier stage for breast, prostate, colon, and lung cancers relative to Medicaid and uninsured groups.

“The most striking system-related difference between [DOD Automated Central Tumor Registry] ACTUR and SEER and between SEER insurance groups is the costs and fee schedules,” the authors pointed out. “Costs for uninsured patients are often prohibitive, which likely explains why odds of later stage diagnosis were highest among uninsured patients. Costs for privately insured patients are highly variable. Some have low out-of-pocket costs, whereas some face higher costs for privately insured beneficiaries were at least $4000 more when compared to those in the MHS. Out-of-pocket costs thus may contribute to the differences observed in stage ad diagnosis between the MHS and SEER-insured groups,” the authors surmised.

Later diagnoses among Medicaid patients could not be explained by constant sharing since those patients have very low out-of-pocket costs, "uninsured patients are often enrolled in and classified under Medicaid shortly after a new cancer diagnosis. This may also contribute to later-stage diagnosis in this group," the study noted.

Overall, the researchers suggested that Medicaid patients “face more barriers in finding physicians who accept their insurance and are more likely to have delays in care due to cost, all of which could possibly lead to a delay in diagnosis. “Delays in time to appointments could also be a factor affecting stage at diagnosis between ACTUR and SEER-insured groups, especially in the case of lung cancer; waiting times for appointments in the MHS are shorter than that reported in a separate survey among civilian physicians,” the authors explained.

The authors also emphasized that their study was performed before the Affordable Care Act eliminated out-of-pocket costs for cancer screening for those not previously covered.

More MHS Research on the Horizon

Shriver noted that several ongoing studies are looking at other aspects of cancer diagnosis treatment in the MHS compared to the general population, which may shed light on the quality of care extended to military families.

Meanwhile, the study published in Cancer Medicine will be discussed in a special panel session at the upcoming annual meeting of the Association of Military Surgeons of the United States (AMSUS) that Murtha is spearheading on February 24th.

• Date Taken: 01.29.2024
• Date Posted: 01.29.2024 13:18
• Story ID: 462637
• Location: BETHESDA, MD, US