Tuesday, June 27, 2017

Studies Show Obamacare Improves Breast Cancer Prognosis, Cutting Medicaid Puts Women at Risk

Two separate analyses demonstrate that women with access to mammograms 
and other breast cancer screenings are diagnosed at earlier, more treatable, 
and less costly stages.

More women were diagnosed with early stage breast cancer after the Affordable Care Act took effect, according to a study published this month in the journal Cancer Epidemiology.  Equally important, there was a decrease in later stage, and more serious, cancers.

Late-stage breast cancer is more costly to treat and is more likely to be fatal than early-stage cancer.

Increases in early diagnoses were higher among African American and Latina breast cancer patients. 
In the past, the cost of mammograms has prevented many Latinas and African Americans to receive mammograms overall or at recommended intervals.

The Affordable Care Act eliminated copayments and other out-of-pocket costs for 45 preventive care services, including mammograms, making them more affordable and leading to the potential for earlier diagnoses, researchers say. Diagnosing breast cancer when it is still in Stage 1 could improve the prognosis for thousands of women and reduce the need for expensive and invasive treatments such as chemotherapy, wrote lead author Abigail Silva, PhD, MPH, of Loyola University Chicago Stritch School of Medicine.

The study included 470,465 breast cancer patients between the ages of 50 and 74 who were covered by private insurance or Medicare and were newly diagnosed with breast cancer. Researchers examined two time periods: 2007-2009 (before the Affordable Care Act took effect) and 2011-2013 (after the act took effect). They used data from the National Cancer Database, which includes approximately 70 percent of all newly diagnosed cancers in the United States from about 1,500 hospitals.

Overall, the number of breast cancers that were diagnosed at Stage 1 increased 3.6 percent, from 54.4 to 58.0 percent. There was a corresponding decrease in Stage 2 and Stage 3 diagnoses, while the proportion of Stage 4 cancers did not change.

The diagnosis of Stage 1 breast cancer increased by 3.2 percentage points among whites, 4.0 percentage points among African Americans and 4.1 percentage points among Latinas. 

Historically, more white women are diagnosed with Stage 1 breast cancer, while African Americans and Latinas are diagnosed at a higher stage. This disparity decreased following the Affordable Care Act, as minorities saw improvements in Stage 1 diagnoses.

This is especially significant for triple-negative breast cancer, which has been shown to be more prevalent and aggressive among African Americans.

Cutting Medicaid Puts Women At Risk
Tennessee women with breast cancer were more likely to be diagnosed at later, more dangerous, stages after a substantial rollback of Medicaid coverage for adults in the state, with the biggest effects being among women in low-income areas, according to an analysis published in the journal Cancer.

Researchers analyzed Tennessee Cancer Registry data from 2002 to 2008 and compared women 
diagnosed with breast cancer who lived in low-income zip codes with a similar group of women who 
lived in high-income zip codes, before and after Tennessee’s Medicaid restrictions. They found that 
women were not only diagnosed at later stages but also experienced more delays in treatment after 
the restrictions were imposed. Low-income women had a 3.3 percent increase in late-stage diagnosis 
compared to those with higher incomes.

Tennessee restricted Medicaid enrollment in 2005

The findings suggest that women did not get screenings or other essential primary care that may 
have led to an earlier diagnosis, according to team leader Wafa Tarazi, PhD, of Virginia 
Commonwealth University. The reason: lack of affordable care.

“Medicaid rollbacks may contribute to widening disparities in health outcomes between low-income women and their wealthier counterparts,” said team leaders Lindsay Sabik, PhD, of the University of Pittsburgh, another team leader.

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