After a well-documented breast cancer journey that lasted nearly a decade, actress Shannen Doherty — best known for her role as Brenda Walsh on the Fox teen drama Beverly Hills, 90210 — died from the cancer on July 13, at age 53. Her publicist shared the news.

Doherty, who revealed her diagnosis in 2015, had stage 4 breast cancer that spread to her lymph nodes, and she received chemotherapy and radiation treatments. She underwent a single mastectomy in May 2015, and in 2017 she said her cancer had gone into remission. The cancer came back in 2020, however, and it eventually spread to her bones and brain.

Doherty’s journey highlighted the importance of health insurance even for the Hollywood actress, who didn’t have insurance when first diagnosed. A lack of insurance can hinder cancer detection and treatment, and it’s a problem that is quite familiar to Colorado School of Public Health Dean and University of Colorado Cancer Center Deputy Director Cathy Bradley, PhD, a public health researcher who studies decisions made at the intersection of work, health insurance, and cancer.

We talked with Bradley about the connection between health insurance status and getting screened or treated for cancer.

Shannen Doherty felt that her lack of health insurance contributed to her not getting the testing or treatment she needed for her breast cancer. Is that a common scenario?

It’s a common scenario for uninsured people. We’ve done a number of studies that showed that after the passage of the Affordable Care Act, which includes free coverage for breast cancer screening, women were more likely to get screened.

The Centers for Disease Control has a program called the National Breast and Cervical Cancer Early Detection Program, which provides free screening for breast and cervical cancer for women who are uninsured or underinsured, but we have found that’s not enough. Our research has shown repeatedly that you must have the insurance coverage. Insurance is the critical step to access.

Is that because having insurance means you’re more likely to go get the screening, or is it that screening is encouraged more frequently when you have insurance, as opposed to putting the onus on you as the individual for the free screening programs?

It’s because insurance covers the cost of screening and any health care that’s needed afterward. When you have health insurance, you prioritize your health more. Think of a 65-year-old who’s newly eligible for Medicare. If they were previously uninsured, they might schedule a doctor visit and get tests they previously put off, because now they can.

If you don’t have health insurance, you are less likely to get screened. Screening is also more likely to occur when you’re in a health care system. When I log on to my electronic medical record portal, I’ll get a message saying, “It’s time for your annual mammogram.” That’s because I have a doctor who is part of the health care system.

What’s that picture like for someone who doesn’t have insurance?

Many people don’t know about free screening programs, and these programs are limited to qualified individuals. You have to be aware of these programs in order to take advantage of their benefits. I don’t know Shannen Doherty’s circumstances, whether she felt a lump or had other symptoms, but as an insured person, if I have symptoms like that, I’m more likely to get them checked out right away. If you don’t have insurance, you might think, “Let’s see if it goes away.”

Are uninsured people who have cancer generally diagnosed at later stages?

That is absolutely the case. Typically, they aren’t diagnosed until they are symptomatic, and by the time they end up in the ER with cancer-related symptoms, it is often too late. They’re having rectal bleeding, they’re coughing up blood, or they feel a massive lump in their breast. They’re almost always late stage. Treatment options for late-stage cancers are getting better, but they’re not as effective as when the cancer is detected in its earliest stage.

This article was originally published July 18, 2024, by the University of Colorado Cancer Center. It is republished with permission.