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.
