• A study has found that cancer diagnoses spike among U.S. adults once they reach age 65.
• The findings suggest people delay receiving health care until they have insurance through Medicare.
• Older Americans often may delay exams for financial reasons, which can lead to unnecessary and premature cancer deaths.

Many Americans push aside health concerns due to financial reasons. A nationwide survey from Bankrate in 2020 found that nearly 1 in 3 U.S. families decided not to seek medical care in the previous 12 months because of cost.

Research from Stanford University published this year in the medical journal Cancer has added evidence that financial limitations may impact health care in the U.S. Scientists analyzed information about hundreds of thousands of Americans ages 61 to 69 who were diagnosed with lung, breast, colon, or prostate cancer (the four most common cancers in the U.S.). They found a significant number of people delayed care until they became eligible for Medicare at age 65.

“Essentially we showed there is a big jump in cancer diagnoses as people turn 65 and are thus Medicare-eligible,” said senior study author Dr. Joseph Shrager, a professor of cardiothoracic surgery, in an interview with Stanford News.

Dr. Shrager and his collaborators pointed to cost as a major factor keeping people from seeking medical treatments and screenings.

“In the years preceding Medicare eligibility, the near elderly are vulnerable because of limited affordable health insurance alternatives and the increasing health risks that develop at approximately that age,” wrote the study authors. They cited data showing 13 percent to 25 percent of near elderly adults are uninsured or have a gap in coverage at some point preceding eligibility for Medicare.

Delayed Diagnoses May Lead to Higher Mortality Rates

In their professional lives, Shrager and his team in the thoracic surgery practice have seen a disproportionately large number of individuals presenting with newly diagnosed lung cancer shortly after their 65th birthday. Analysis of their division’s data over the past decade confirmed a two-fold increase in the number of pulmonary lobectomies for lung cancer performed for people at age 65 compared to aged 64.

The doctors speculated that Medicare eligibility might be behind this leap in surgeries and decided to dig deeper. Using the Surveillance, Epidemiology, and End Results (SEER) Program — a National Cancer Institute effort that collects incidence and survival data on people with cancer — the scientists identified:

• 134,991 individuals with lung cancer
• 175,558 with breast cancer
• 62,721 with colon cancer
• 238,823 with prostate cancer

All were 61 to 69 years old and diagnosed between 2004 and 2016.

The researchers discovered that diagnoses for all four cancers spiked at age 65. Lung cancer rates consistently increased 3 percent to 4 percent each year for people ages 61 to 64. Then at 65, that percentage doubled. Increases in colon-cancer diagnoses were more significant: Cases ticked up by a percent or two leading up to age 65 and then jumped about seven-fold to nearly 15 percent when people hit Medicare eligibility.

The investigation found that people older than 65 with health insurance who received a cancer diagnosis were more likely to undergo surgical intervention. Additionally, the five-year cancer-specific mortality rates were higher (and thus worse) for people in the uninsured pre-Medicare group compared to those who had Medicare:

• Lung cancer — 86.3 percent five-mortality rate for pre-Medicare group vs. 78.5 percent for the post-Medicare group
• Breast cancer — 32.7 percent vs. 11 percent
• Colon cancer — 57.1 percent vs. 35.6 percent
• Prostate cancer — 16.9 percent vs. 4.8 percent

All of the results supported the hypothesis that people are delaying cancer-related diagnostic and therapeutic interventions until they become Medicare-eligible, according to Dr. Shrager and his colleagues.

“This delay may result in unnecessary cancer death,” concluded the study authors. “These findings obviously are of great importance at a time during which Medicare-for-all is being considered in our national political debate.”