The implementation of the Affordable Care Act (ACA), which increased insurance coverage, was associated with an increase in the diagnosis of several screenable cancers at an earlier stage, according to data (abstract 6521) presented at a press conference ahead of the 2017 American Society of Clinical Oncology (ASCO) Annual Meeting.
“Implementation of the ACA was significantly associated with a shift to early stage at diagnosis for colorectal, female breast, and lung cancer,” said Xuesong Han, PhD, strategic director of health policy and healthcare delivery research at the American Cancer Society, during the press conference. “Shifts to early stage for colorectal cancer and lung cancer were mainly seen in Medicaid-expansion states, while the shift for female breast cancer was regardless of Medicaid expansion.”
According to Han, there is extensive evidence to show that people without insurance are more likely to be diagnosed with cancer at a later stage, especially for cancers that can be diagnosed using screening. The ACA had a measurable impact on increasing the number of people in the United States with health insurance. This study explored changes in the proportion of screenable cancers diagnosed at stage I.
Using data from the National Cancer Data Base, the researchers identified patients with cancer aged 18 to 64 with screenable cancers such as female breast cancer, colorectal cancer, cervical cancer, prostate cancer, and lung cancer, diagnosed from 2013–2014. These cancers have screening methods that allow for detection at an early stage; however, the researchers pointed out that there is still some debate about the efficacy and appropriate use of some of these methods.
For this study, they calculated the percentage of stage I disease of each cancer type before and after the ACA. There was a 1% increase in stage I diagnosis for all cancers examined except prostate cancer. For breast cancer the increase was from 47.8% to 48.9%; for cervical, 47.3% to 48.8% (not statistically significant); for lung, from 16.6% to 17.7%; and for colorectal cancer, from 22.8% to 23.7%.
There was no increase noted for prostate cancer. Instead, the rate of stage I diagnosis decreased by 1% from 18.5% to 17.2%. Han noted that this decrease may reflect the recent US Preventive Services Task Force recommendation against routine prostate cancer screening.
The researchers also examined changes in stage I diagnosis according to whether or not states decided to expand Medicaid insurance. They found that the decreases in prostate cancer screening and the increases in breast cancer screening were consistent regardless of Medicaid expansion, and the increases in colorectal cancer and lung cancer were mainly in Medicaid-expansion states.
Commenting on the study, Bruce E. Johnson, MD, ASCO president-elect, said that although the changes seen in the study were not enormous, the reality is that changes in screening uptake are slow.
“ASCO supports the relative ease of access to screening capabilities, and one of the aspects of the ACA was that most cancer screening was covered,” Johnson said. “We advocate for patients to have early access to screening.”