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Recommendation for closing the health equity gap in cancer care

Experts with some of the state’s major health care systems said North Carolina needs to expand Medicaid to reduce the health equity gap in cancer care.

They spoke during an online presentation this week sponsored by the American Cancer Society Cancer Action Network.

White and Black women are diagnosed with breast cancer at about the same rates, but Black women are more likely to die from it, according to information from the North Carolina Central Cancer Registry and the State Center for Health Statistics that the state Department of Health and Human Services complied.

North Carolina can learn from other states’ experiences with Medicaid expansion, said Dr. Katherine Reeder-Hayes. High-quality research has described differences in cancer treatment in states that have expanded Medicaid and those that have not, she said.

Reeder-Hayes is an associate professor of medicine at UNC whose research focuses on racial disparities in breast cancer.

“Expansion of Medicaid enhances access to cancer screening, particularly in breast cancer screening. We’ve seen mammography rates going up in Medicaid expansion states compared to those that have not expanded Medicaid,” she said.

Additionally, the gap in “timeliness of treatment” or how quickly patients start treatment after they’re diagnosed with advanced cancer has closed in Medicaid expansion states, she said.

“I think we’re accumulating more and more evidence that expanding Medicaid improves cancer care delivery and cancer outcomes,” Reeder-Hayes said.

Disparities are not limited to breast cancer. Black men are more likely to be diagnosed with prostate cancer and to die from it, and Black women and men are more likely to be diagnosed with and die from colorectal cancer.

North Carolina is one of a dozen states that has not adopted Medicaid expansion, which would allow more low-income adults to have health insurance.

Gov. Roy Cooper has pushed for North Carolina to expand Medicaid, but the idea has so far failed to win support from the Republican-led legislature.

A section of the Build Back Better legislation in Washington would temporarily close that gap, but the bill is stalled in Congress.

Medicaid expansion would help extend health care services to rural areas of the state, said Ronny Bell, director of the Office of Cancer Health Equity at the Wake Forest Baptist Comprehensive Cancer Center.

Some people travel three hours to get to the cancer center, he said.

“To the extent that we can break down some of those barriers through Medicaid expansion, I think we would have a significant impact on our rural communities,” he said.

Delayed treatment is more expensive and takes more time from patients’ lives, the panelists said.

“It’s a matter of where we’re going to spend our money,” said Angelo D. Moore, associate director for community outreach, engagement, and equity at the Duke Cancer Institute.

“We talk about structural barriers and structural drivers and structural racism and discrimination. By us not expanding health care, we’re putting a whole population of people at a disadvantage. We need to be more in the prevention mode than reactive mode,” he said. “Expanding Medicaid is an action we can do to make a difference.”

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