ACA Reduced Socioeconomic Disparities in Breast Cancer Screening

The use of mammography, but not colonoscopy, has increased in the post–Affordable Care Act (ACA) years, which eliminated out-of-pocket expenditures for these recommended services, according to the results of a study published in Cancer.

“Although we were unable to measure a direct cause and effect relation, we found that after implementation of the ACA, there was reduction in socioeconomic disparities for screening mammography but not colonoscopy,” wrote  Gregory S. Cooper, MD, of the division of gastroenterology at the University Hospitals Cleveland Medical Center, and colleagues. “The findings support the removal of out-of-pocket expenditures as a barrier to the receipt of recommended preventive services but emphasize that for colonoscopy, other factors such as a fear of sedation, perceived discomfort, and a need for bowel preparation should be considered.”

Cooper and colleagues used Medicare claims data to study whether or not there had been changes in the uptake of mammography and colonoscopy among fee-for-service Medicare beneficiaries before and after ACA implementation. They studied women aged 70 or older who had not undergone mammography in the previous 2 years (n = 862,267) and men and women who were 70 and older who were at increased risk for colorectal cancer and had not undergone colonoscopy in the past 5 years (n = 326,503). They also looked at the receipt of these procedures in the 2 years prior to ACA (2009–2010) and the 2 years after (2011–2012).

The researchers found that during both pre-ACA and post-ACA time periods there appeared to be an association between lower socioeconomic status and less receipt of mammography. However, after the legislation was implemented, the odds ratios differed between the two periods. Post-ACA, the disparities were smaller than pre-ACA. Additionally, rates of mammography increased from pre-ACA to post-ACA for all socioeconomic groups.

“Using a cohort of Medicare beneficiaries, we found that after implementation of the ACA, not only was there an increase in mammography uptake, but the gap in the receipt of mammography between the lowest and highest socioeconomic status strata narrowed,” the researchers wrote.

For colonoscopy, data revealed that both pre-ACA and post-ACA there was an association between education level and income with increased receipt of colonoscopy. However, implementation of ACA did not have an effect on colonoscopy uptake. Odds ratios comparing pre- and post-ACA colonoscopy rates showed a slight decrease in uptake post-ACA.

Based on these results, the researchers suggested that “future studies examine the ACA’s impact in other populations, including newly insured individuals.”