Study Finds Medicaid Expanded States Diagnose Breast Cancer at Earlier Stage

Patients in states with expanded Medicaid coverage through the Affordable Care Act (ACA) saw a higher percentage of women with breast cancer diagnosed at an earlier stage of disease, according to a study published in JAMA Surgery.^1-2

More, expansion of Medicaid was associated with both a reduced number of uninsured patients and a decrease in the incidence of advanced-stage breast cancer.¹

“If the cancer is diagnosed early, generally treatment is definitive and women have good overall survival,” first author on the study Justin Le Blanc, MD, said in a press release.² “It's important to get women health care access early. And when patients have access to health care, they're more likely to utilize it.”

The study found an advanced-disease reduction from 21.8% (4603 of 21,127 patients) to 19.3% (4280 of 22,150 patients; P < .001) in expansion states across all races. In non-Medicaid expansion states, the reduction was smaller, from 24.2% (3604 of 14,870 patients) to 23.5% (3072 of 13,088 patients; P = .14).

More, between 2012 and 2016, 4% of the study’s population was uninsured or had Medicaid. In expansion states, the rate of uninsured patients reduced from 22.6% (4771 of 21,127 patients) to 13.5% (2999 of 22,150 patients; P < .001) compared to a reduction from 36.5% (5431 of 14,870 patients) to 35.6% (4663 of 13,088 patients; P = .12) in non-Medicaid expansion states.

Specifically, a particular benefit was observed for African American patients and patients younger than 50 years. Incidence of advanced disease for African American patients decreased from 24.6% (1017 of 4136 patients) to 21.6% (920 of 4259 patients; P < .001) in Medicaid expansion states. More, in non-Medicaid expansion states, the incidence of advanced disease remained at 27% (27.4% [1220 of 4453 patients] to 27.5% [1078 of 3924 patients]; P = .94).

“This result was particularly striking since African American women generally present with more aggressive cancer and decreased survival rates,” senior author Tristen Park, MD, said in a press release.² “Again, no significant changes were observed in diagnosis stage among this population in non-expansion states.”

A total of 1,796,902 women were included in the study population. The group of researchers analyzed women with breast cancer from 31 Medicaid expansion states and 14 non-Medicaid expansion states. The study employed the American College of Surgeons National Cancer Database, comparing pre-expansion data (2012-2013) to post-expansion data (2015-2016) to assess Medicaid expansion in 2014.

Data from 2007 to 2016 was assessed to analyze the relationship between breast cancer stage and race, age, and insurance status.

Moving forward, the Yale researchers plan to compare the medical services provided to Medicaid insurance patients versus medical services for patients with other insurances or no insurance at all.

In the United States, breast cancer is the most common type of cancer among women. Breast cancer is estimated to account for 279,100 diagnoses and 42,170 deaths in the United States this year.

“Most women with breast cancer live quite a long time if it's caught early and treated correctly. The next step is that we should also try to give them a good quality of life,” Park said in a press release.²

References:

1. Le Blanc JM, Heller DR, Friedrich A, et al. Association of Medicaid Expansion Under the Affordable Care Act With Breast Cancer Stage at Diagnosis. JAMA Surg. doi:10.1001/jamasurg.2020.1495.

2. Yale study: Breast cancer found earlier in states with expanded Medicaid [news release]. Yale News. Published July 1, 2020. https://news.yale.edu/2020/07/01/yale-study-breast-cancer-found-earlier-states-expanded-medicaid. Accessed July 21, 2020.