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Survival disparities increase for patients without health insurance following FDA approval of immune checkpoint inhibitors for advanced cancer, data shows

​In a new study released on July 7, ACS researchers found that the introduction of immune checkpoint inhibitors (ICIs) following FDA approval was associated with a widening survival disparity between people without health insurance and those with private insurance, newly diagnosed with advanced stage melanoma, non-small cell lung cancer (NSCLC), or renal cell carcinoma (kidney cancer). ICIs are a type of advanced immunotherapy and work by helping the immune system better find and attack cancer cells in the body. While offering promising outcomes for many patients, ICIs are also among the highest-cost cancer drugs. The study was published in the Journal of the American Medical Association (JAMA) Network Open.

“These findings are concerning, especially as ICIs are being used more frequently in treating people with both early and late-stage cancers,” said Dr. Jingxuan Zhao, senior scientist, health services research at ACS, and lead author of the study. “ICIs can be lifesaving; however, cancer patients without health insurance coverage may be unable to afford them due to their high costs.”

“Health policies expanding access to insurance coverage options and making new treatments more affordable are needed. Expanding Medicaid to individuals without health insurance coverage may improve their access to effective cancer treatments that are also costly, such as ICIs,” Dr. Zhao added.

“Having comprehensive, affordable health insurance is a major determining factor in surviving cancer, especially as promising new – but also costly – treatments, like ICIs, become available. That’s why ACS CAN has long advocated for increased access to quality, affordable health coverage – made increasingly urgent with recent Congressional action that significantly cuts Medicaid funding and makes affordable health insurance coverage unattainable for millions nationwide,” said Lisa A. Lacasse, president of ACS’s advocacy affiliate, ACS CAN.

ACS researcher Dr. Robin Yabroff contributed to this study.

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  • Research finds racially and economically segregated communities increase advanced-stage breast and cervical diagnoses

    ​In a new study released on July 23, ACS scientists found that people living in racially and economically segregated neighborhoods in New York City (NYC) were more likely to be diagnosed with advanced-stage breast and cervical cancer. Colorectal cancer was studied, but no disparities were found. This study is the first to use census-tract data—the most granular geographic level available from cancer registries—to examine how racialized economic segregation influences advanced-stage diagnoses of all three major screenable cancers at once. The findings are published in the Journal of the National Cancer Institute (JNCI).​​​

    “Our research shows that structural barriers in segregated neighborhoods continue to delay diagnosis for breast and cervical cancers—even among individuals eligible for screening,” said Dr. Qinran Liu, post-doctoral fellow, cancer disparities research at ACS, and lead author of the study. “But there is positive news. We found no disparities in stage at diagnosis for colorectal cancer. This may in part reflect the impact of local equity-focused initiatives for early detection of colorectal cancer in NYC. However, the results for colorectal cancer may not be applicable to other areas, especially those without such early detection initiatives.”

    “Our findings have direct implications for cancer prevention and early detection efforts by identifying neighborhoods with the greatest disparities in stage at diagnosis,” Dr. Liu added. “This information can inform targeted resource allocation and guide interventions such as patient navigation services and investments in healthcare infrastructure—strategies that can facilitate earlier diagnosis with the goal of improving outcomes.”

    “This study underscores the role of demographic data in identifying disparities in cancer risk, incidence, diagnosis, and outcomes, and helping inform tailored strategies and outreach efforts to address these disparities,” said Lisa A. Lacasse, president of ACS’s advocacy affiliate ACS CAN. “Policies that ensure the timely collection and reporting of complete and accurate demographic data, along with policies that increase access to timely, affordable care, are key to saving lives. Protecting federal funding for the National Center for Chronic Disease Prevention and Health Promotion and the Division of Cancer Prevention and Control at the Centers for Disease Control and Prevention is essential to ensure the continuation of lifesaving programs that provide millions of cancer screenings, support state cancer registries, and deliver critical prevention, early detection and survivorship services to communities across the country.”

    Other ACS researchers contributing to the study include Dr. Daniel Wiese, Dr. Jordan Baeker Bispo, Dr. Ahmedin Jemal, and senior author Dr. Farhad Islami.

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  • Study suggests firefighters face increased mortality rates for several cancers

    ​It’s estimated that more than 15 million firefighters protect the inhabitants of 60 countries worldwide. Though the hazardous exposures encountered by firefighters vary, potential exposures include several known or suspected carcinogens. After more than thirty years of follow-up, a new study released by ACS researchers on July 28, found that firefighters are at an increased risk of mortality from skin, kidney, and other types of cancer. This research follows a 2022 review by the International Agency for Research on Cancer (IARC) that found sufficient evidence that occupation as a firefighter causes mesothelioma and bladder cancer, but limited or inadequate evidence for causation for all other cancer types. The ACS study was published in the International Journal of Epidemiology.​

    “Our findings support the growing body of research linking firefighter exposures to cancer risk,” said Dr. Lauren Teras, senior scientific director, epidemiology research at ACS and lead author of the study. “The associations with skin, kidney, prostate, and colorectal cancer notably help to fill gaps for cancers that were considered to have limited or inadequate evidence in the previous IARC review.”

    Because cancers often take many years to develop, the authors note this research highlights the advantages of studies like the ACS Cancer Prevention Study-II that follow participants for decades and can account for other factors like smoking and socioeconomic status. The higher risk of dying from lung cancer was only clear after studying participants for 30 years. The study also calls attention to the importance of proper personal protective equipment for the skin, as the rates of fatal skin cancers were higher among firefighters in this study population.

    “Although this isn’t favorable news, this study shines a spotlight on the long-term risks firefighters face beyond the immediate dangers of fighting a fire. Continued efforts to safeguard the health of firefighters by increasing access to cancer screening, early detection, and prevention are paramount,” Dr. Teras added. “This population plays a crucial role in our communities as first responders and protectors of life and property.”

    Other ACS researchers contributing to the study include Dr. Ryan Diver, Dr. Robert Smith, Dr. William Dahut, Ellen Mitchell, James Hodge, Emily Deubler, and senior author Dr. Alpa Patel.

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  • The new edition of Cancer Atlas released

    ​Today, the American Cancer Society announced the release of The Cancer Atlas, 4th Edition, a collaborative effort to uncover global cancer patterns and stark inequalities in addressing the burden of the disease. Produced by ACS and the International Agency for Research on Cancer (IARC), The Cancer Atlas reports that an estimated 50% of all cancer deaths worldwide are attributed to modifiable risk factors. These findings will be presented at the Cancer Prevention Research Conference 2025, hosted by ACS and Cancer Research United Kingdom (CRUK) in London, from June 25 to 27.  

    The Cancer Atlas presents the most up-to-date scientific data and evidence-based consensus across the entire cancer continuum. More than 70 leading experts and scientists from 35 institutions worldwide contributed to the book’s 47 chapters. As with previous editions, the 4th edition of The Cancer Atlas is grouped into three sections: Risk Factors, The Burden, and Taking Action. Additional chapters address timely and emerging essential topics, including Alcohol, Climate Change and Cancer, and Health System Resilience.
     
    “This global collaboration to produce the 4th edition of The Cancer Atlas is critical in advancing the American Cancer Society’s vision to end cancer as we know it, for everyone,” said Dr. Ahmedin Jemal, ACS senior vice president, surveillance & health equity science and lead editor of the report. “A substantial proportion of cancer in each country can be prevented by implementing resource-stratified cancer prevention and control measures, including health promotion, tobacco control, and vaccination. However, such measures are not implemented optimally in many countries because of a lack of political will.” 

    Globally, there are 19 million people diagnosed with cancer and 10 million deaths each year (excluding non-melanoma skin cancer). Without intervention, these numbers could rise to over 33 million cases and 18 million deaths by 2050, solely due to the aging and growth of the population. Lung cancer continues to be the most commonly diagnosed cancer and the leading cause of cancer death worldwide, killing about 1.8 million people every year. Still, over 1 billion people worldwide use tobacco products due to the incomplete implementation of proven effective tobacco control measures.
     
    “The Cancer Atlas brings attention to some of our most pressing challenges and biggest opportunities to address the global cancer burden,” said Dr. William Dahut, ACS chief scientific officer. “Together, we can leverage this research to lessen cancer’s footprint on our global community by increasing education, prioritizing screening and prevention, and improving care.”  

    Additional highlights from the report include: 

    • Many lower-income countries are experiencing a sharp rise in incidence of lung, colorectal, and breast cancers in the wake of increasing prevalence of risk factors associated with economic development (e.g., smoking, unhealthy diet, alcohol use, excess body fatness and physical inactivity, and lower fertility), although infection-related cancers (e.g., cervical cancer) still prevail. 

    • Cervical cancer remains the leading cause of cancer death among women in 29 countries in sub-Saharan Africa. Less than 10% of women aged 30-49 years, in many of these countries, have ever had screening, compared to over 80% in most Western countries. Coverage of the highly effective HPV vaccine ranges widely from 3% in Central and Southern Asia to 86% in Australia and New Zealand.

    • Cancer death rates are disproportionately higher in many low-income countries due to poorer survival. Over 90% of the population in low- and middle-income countries lack access to safe and timely surgical care; and 23 low-and middle-income countries with populations over 1 million, mostly in sub-Saharan Africa, did not have access to radiotherapy.

    • Among young adults, colorectal cancer incidence rates are rising in many high-income countries in contrast to a decrease in older adults due to reduced smoking and screening uptake. The increase may in part reflect the obesity epidemic and consumption of an unhealthy diet. 

    • Universal health coverage (UHC) ensures access to quality health services without financial strain, yet in 2021, around 4.5 billion people (57% of the world population) still lacked full essential coverage. Implementing an essential set of cancer services as part of UHC could save more than 7 million lives by 2030.

    The Cancer Atlas is available in print and digital formats. It was designed to ensure user-friendly, accessible, and downloadable descriptions and graphics that can be easily used by cancer-control advocates; government, private, and public health agencies; policymakers; patients and survivors; and the general public.  

    Other ACS editors for the 4th edition of The Cancer Atlas are Dr. Hyuna Sung and Kieran Kelly.  

    The 2026 Cancer Prevention Research Conference will be held in Atlanta, Georgia. 

  • Study finds Medicaid expansion increased Medicaid coverage, early-stage cancer diagnosis and survival among adults 65 and older

    A new study by researchers at ACS shows Medicaid expansion was associated with an increase in Medicaid coverage, early-stage cancer diagnoses, and improved two-year survival among patients diagnosed with cancer aged 65 years and older. The findings were presented at this year’s American Society of Clinical Oncology (ASCO) annual meeting in Chicago.

    In the report, led by Kewei Sylvia Shi, MPH, associate scientist, health services research at ACS, researchers identified patients 65 years or older using the National Cancer Database. They analyzed data of newly diagnosed patients with cancer between 2010 and 2022 residing in areas with a median household income below 200% of the federal poverty level. Researchers applied a quasi-experimental difference-in-differences design, with multivariable linear probability models, to compare the changes in the percentage of dual-eligible or Medicaid-only coverage, early stage at diagnosis, and two-year survival post (vs. pre) Medicaid expansion in expansion states compared with non-expansion states.

    Study results included a total of 1,461,540 patients with cancer, with 881,692 patients from expansion states and 579,848 patients from non-expansion states. After adjusting for sociodemographic characteristics, the percentage of patients with dual or Medicaid-only coverage increased from 10.3% to 11.3% in expansion states and decreased from 9.4% to 8.1% in non-expansion states, resulting in a net increase of 1.25 percentage points associated with Medicaid expansion. Differences were more pronounced among patients over 85 years, females, non-Hispanic Black, metropolitan residents, and those with comorbidities.

    Early-stage (0,I,II) cancer diagnoses decreased more in non-expansion states (55.6% to 53.1%) than in expansion states (53.5% to 51.9%), resulting in a net 1.00 percentage points increase. The protective effects of Medicaid expansion were stronger for lung and bronchus and oral cavity and pharynx cancers.

    Two-year overall survival rates increased from 58.8% to 62.4% in expansion states and from 59.2% to 62.5% in non-expansion states, leading to a net benefit of 0.77 percentage points. Improvements were most notable for stage IV, lung and bronchus, kidney, and bladder cancers.

    Researchers stress these findings underscore the spillover benefits of Medicaid expansion in supporting low-income elderly populations and the importance of indirect benefits when evaluating Medicaid expansion’s broader impact.

  • County-level medical debt associated with delays in cancer treatment among newly diagnosed

    ​A new study by researchers at ACS shows that a higher county-level share of medical debt in collections was associated with delays in treatment initiation among individuals newly diagnosed with cancer. The findings were presented at this year’s American Society of Clinical Oncology (ASCO) annual meeting in Chicago.

    In the report, led by Dr. Jingxuan Zhao, senior scientist, health services research at ACS, researchers identified adults aged 19 years and older who were newly diagnosed with cancer from 2012 to 2021. They used the Colorado Central Cancer Registry linked to the Colorado All-Payer Claims Database, which was combined with information on county-level share of adults with medical debt in collections. Scientists examined the associations of county-level medical debt and receipt of any treatment within 90 days after cancer diagnosis overall and by selected cancer sites (acute leukemias, lymphomas, breast, colorectal, and lung cancers) and health insurance coverage, adjusting for sociodemographic characteristics.

    The study showed that, among 35,789 individuals newly diagnosed with cancer, individuals living in counties with a higher share of adults with medical debt in collections had a lower likelihood of initiating treatment within 90 days after diagnosis compared to those living in counties with a lower share of adults with medical debt. When stratified by cancer site, higher county-level medical debt was associated with a lower likelihood of timely treatment initiation among individuals diagnosed with breast and colorectal cancers. When stratified by health insurance, higher county-level medical debt was associated with a lower likelihood of timely treatment initiation among individuals aged 19-64 years with coverage through private health maintenance organization plans and Medicaid.

    Researchers stress policies aimed at preventing and alleviating medical debt could be effective strategies for improving access to timely cancer treatment.

  • Study shows that pre-diagnosis adverse financial events increase cancer mortality risk

    A new study by ACS researchers shows court-documented adverse financial events (AFEs) of pre-diagnosis bankruptcy, lien, or eviction were associated with increased risk of all-cause and cancer-specific mortality for multiple cancer types. The findings underscore lasting adverse consequences of patient financial vulnerability prior to incurring high out-of-pocket costs of cancer treatment. The data was presented at this year’s American Society of Clinical Oncology (ASCO) annual meeting in Chicago.

    In the study, led by Dr. Robin Yabroff, scientific vice president, health services research at ACS, researchers analyzed records of adults aged 21 to 69 years diagnosed with common cancer types, including bladder, female breast, colorectal, kidney, lung and bronchus, oral cavity/pharynx, or prostate cancers or melanoma during 2014-2015. The individuals were identified from the SEER population-based registries for Seattle, Louisiana, and Georgia. Registry data was linked with LexisNexis consumer data to identify history of court-documented AFEs of bankruptcies, liens, and evictions. Vital status and cause of death were examined through December 31, 2021.

    Study results showed that of 58,796 individuals diagnosed with one of the eight selected cancers, 21,694 (36.9%) had a pre-diagnosis AFE, and there were 16,714 deaths (28.4%) during the study period. Pre-diagnosis AFEs were associated with a higher risk of all-cause mortality for individuals diagnosed with female breast, colorectal, oral cavity/pharynx, and prostate cancer and early- and late-stage melanoma, in adjusted models. Pre-diagnosis AFEs were also associated with a significantly higher risk of cancer-specific mortality for these five cancers.

    Researchers stress that the findings are especially timely, with growing efforts by health care providers to screen and address patient health-related social needs as part of comprehensive oncology care.​

  • Study finds Medicaid expansion improves cancer survival among people in rural and high-poverty communities

    ​A new study by researchers at ACS shows Medicaid expansion significantly improved 5-year cause-specific cancer survival and overall survival among people residing in rural and high-poverty communities. The findings were presented at this year's American Society of Clinical Oncology (ASCO) annual meeting in Chicago.

    In the report, led by Elizabeth Schafer, MPH, associate scientist, surveillance and health equity science at the ACS, researchers analyzed all tumors diagnosed during 2007-2008 (pre-Medicaid expansion) and 2014-2015 (post-Medicaid expansion).

    Study results included a total of 1,423,983 cancer cases diagnosed between 2007 and 2008 and 2014 and 2015 in Medicaid expansion and non-expansion states. For all cancers combined, the non-significant adjusted net increase in 5-year cause-specific cancer survival associated with Medicaid expansion was 0.08 percentage point. By sociodemographic factors, the improvements in cause-specific survival were greater in expansion states among individuals residing in rural and in high-poverty communities, among non-Hispanic White individuals, American Indian/Alaska Native, and non-Hispanic Black individuals, though not statistically significant for the latter two populations. Similarly, the net gains in 5-year overall survival in expansion states were statistically significant among non-Hispanic Black and non-Hispanic White individuals, and among individuals residing in rural and high-poverty areas.

    Researchers stress improvements in long-term survival, especially among high-poverty and rural communities, underscore the importance of maintaining Medicaid expansion and further expanding in the 10 remaining states to broadly cover low-income adults and help reduce disparities in cancer survival outcomes.

  • More evidence links physical activity with improved cancer survival, study finds

    ​​A new large analysis led by ACS researchers shows engaging in leisure-time moderate-to-vigorous physical activity (MVPA) after a cancer diagnosis improves survival for people with different cancer types, including bladder, breast, colon, endometrial, kidney, lung, oral, prostate, rectal, and respiratory cancer. 

    “The effects of cancer treatment can wear you down physically and mentally,” said Dr. Erika Rees-Punia, senior principal scientist, population science research at ACS and lead author of the study. “This can make exercise feel like a daunting task, but doing some exercise is better than doing none. Finding an exercise that you enjoy or exercising with a friend can make it more approachable.”

    This is the first longitudinal study of the relationships between postdiagnosis physical activity and overall mortality in bladder and oral cavity cancer survivors and is the largest study to quantify associations within survivors of endometrial, kidney, and lung cancer. The findings were published in the Journal of the National Cancer Institute (JNCI).

    “For decades, it’s been known that consistent exercise can help people live healthier lives,” Rees-Punia added. “Our findings bring more critical evidence that being physically active after a cancer diagnosis can have a meaningful impact on your likelihood of survival.”

    Other ACS researchers contributing to the study include Dr. Lauren Teras, Christina Newton, Dr. Lauren Bates-Fraser, Den E Bloodworth, and senior author Dr. Alpa Patel.
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