In a new study by Yale Cancer Center (YCC), researchers have demonstrated that in states with expanded Medicaid coverage through the Affordable Care Act (ACA) a higher percentage of women with breast cancer had their disease diagnosed at an early stage. No such change was seen in states that didn’t expand their coverage. The findings were published today in JAMA Surgery.
Breast cancer is the most common cancer among women in the United States, with an estimated 279,100 diagnoses and 42,170 deaths this year. “If the cancer is diagnosed early, generally treatment is definitive and women have good overall survival,” said Justin Le Blanc, M.D., a surgical resident at YCC and Smilow Cancer Hospital and first author on the study. “It's important to get women healthcare access early. And when patients have access to healthcare, they're more likely to utilize it.”
Researchers analyzed women diagnosed with breast cancer in 31 states that boosted their Medicaid coverage under the ACA and 14 states that did not. In the expansion states, where the average rate of uninsured breast cancer patients diminished from 23% to 14%, the rate of women diagnosed with advanced stages of the disease dropped from 23% to 20%. In the non-expansion states, no significant changes were seen.
In the Yale study, differences in diagnosis were notable among African American women, with the percentage of those diagnosed at advanced stages decreasing from 25% to 21% in expansion states. “This result was particularly striking since African American women generally present with more aggressive cancer with decreased survival rates,” said Tristen Park, M.D., Assistant Professor of Surgery (Oncology) at Yale School of Medicine and senior author on the paper. “Again, no significant changes were observed in diagnosis stage among this population in non-expansion states.”
Additionally, the scientists found that younger women with breast cancer were also diagnosed at an earlier stage in the expansion states. Among women under the age of 50, the average rate of diagnosis at advanced stages lowered from 23% to 21% in these states, while the rate stayed constant in the non-expansion states at 26%. This earlier diagnosis is important because breast cancer is much rarer and more aggressive in younger patients, the researchers say.
The Yale study employed the American College of Surgeons National Cancer Database, focusing on 71,235 women diagnosed with breast cancer from 2012 to 2013 (before ACA expansion) and from 2015 to 2016 (after expansion).
The Yale scientists will continue their research by comparing the medical services provided to patients with Medicaid insurance with the services received by women with other types of insurance or no insurance at all. “For example, are these women with Medicaid now receiving increased use of chemotherapy, radiation therapy, reconstructive surgery, or genetic testing?” said Le Blanc. “Most women with breast cancer live quite a long time if it's caught early and treated correctly,” Park said. “The next step is that we should also try to give them a good quality of life.”
Other contributors to the paper included Yale’s Danielle Heller, M.D., Ann Friedrich, M.D., and Donald Lannin, M.D.