Affordable Care Act increases screening, early diagnosis of certain cancers

An uptake in cancer screening after implementation of the Affordable Care Act in 2014 has shifted the diagnosis of breast, lung and colorectal cancers to an earlier, more treatable stage, according to data scheduled for presentation at the ASCO Annual Meeting.

Perspective from W. Michael Alberts, MD, MBA

“We know from previous research that lack of insurance typically results in diagnosis of cancer at a later, and usually less treatable stage,” Xuesong Han, PhD, cancer epidemiologist and strategic director of health policy and health care delivery research at the American Cancer Society, said during a press conference.

Xuesong Han

However, implementation of two major components of the Affordable Care Act (ACA) — Medicaid expansion and the Marketplace exchange — has increased insurance coverage for individuals aged 18 to 64 years, Han said.

Han and colleagues used the National Cancer Data Base to evaluate data from nonelderly patients diagnosed with cancer between 2013 and 2014 to determine any trends in changes in stage at diagnosis after ACA implementation.

The study included 121,855 female patients with breast cancer (aged 40-64 years); 39,568 patients with colorectal cancer (aged 50-64 years); 11,265 patients with cervical cancer (aged 21-64 years); 59,626 patients with prostate cancer (aged 50-64 years) and 41,504 patients with lung cancer (aged 55-64 years).

The researchers compared trends in cancer stage at diagnosis during the first 9 months of 2013 — considered baseline — with the last 9 months of 2014. Researchers considered the period between a “washout” or phase-in period for the implementation of the ACA.

After ACA implementation, the proportion of cancers diagnosed at stage I increased significantly for breast cancer (48.9% vs. 47.8%; prevalence ratio [PR] = 1.02; 95% CI, 1.01-1.03); colorectal cancer (23.7% vs. 22.8%; PR = 1.04; 95% CI, 1-1.08); and lung cancer (17.7% vs. 16.6%; PR = 1.06; 95% CI, 1.02-1.11). For cervical cancer, an insignificant shift toward stage I disease occurred (48.7 % vs. 47.2%; PR = 1.02; 95% CI, 0.98-1.06).

“Shifts to early stage for colorectal cancer and lung cancer were mainly seen in Medicaid expansion states, whereas shift for female breast cancer occurred regardless of Medicaid expansion status,” Han said.

The percentage of stage I decreased for prostate cancer (17.2% vs. 18.5%; PR = 0.93; 95% CI, 0.9-0.96).

“We think this [percentage] may reflect the U.S. Preventive Services Task Force recommendation against PSA testing in 2012,” Han said.

“More research is needed to see if this shift in stage at diagnosis is a short-term effect or continues over time,” Han added. – by Melinda Stevens

Reference:

Han X, et al. Abstract 6521. Scheduled for presentation at: ASCO Annual Meeting; June 2-6, 2017; Chicago.

Disclosures: The researchers report no relevant financial disclosures.

Perspective

W. Michael Alberts, MD, MBA

This is a very interesting abstract. You can quibble about the statistics and the cause-and-effect relationship; I don’t think this abstract proves anything beyond a shadow of a doubt, but it is an interesting premise. The researchers state the increase was low at 1%, but they also point out that 1% of 273,000 is a very big number. If this study were true, it would have a lot of importance, especially with the dismantling of the Affordable Care Act.

W. Michael Alberts, MD, MBA

H. Lee Moffitt Cancer Center and Research Institute

Disclosures: Alberts reports no relevant financial disclosures.