The Affordable Care Act's expansion of Medicaid makes it more likely that a woman will be diagnosed with breast cancer earlier rather than at an advanced, harder-to-treat stage, new research suggests.
Not all U.S. states expanded Medicaid coverage after the Affordable Care Act (also known as Obamacare) made it possible in 2010. That's because the Supreme Court made it optional for states to do so in 2012.
In the new study, researchers compared Southern states that did and didn't expand Medicaid coverage, and they found striking differences in breast cancer care. Their findings were published Feb. 1 in the Journal of the American College of Surgeons.
Researchers were inspired to make this comparison between neighboring states in part because senior study author Dr. Quyen Chu, a surgical oncologist with the Orlando Health Cancer Institute in Florida, witnessed women traveling from Texas, a state without coverage, to Louisiana, which offered care, when he worked at the Louisiana State University Health Sciences Center.
"Those encounters are something you don't really hear about. But, from my personal experience, that's what I saw during my time when I was practicing in Louisiana,” he said in a journal news release.
"There are vulnerable patients who don't have access to care, and we wanted to look at the facts to know whether the ACA expansion had an impact on those patients," Chu said. "We wanted to be apolitical about it; we didn't know the answer before doing the study."
Researchers studied this by identifying patients on Medicaid or without insurance who were diagnosed with invasive breast cancer from 2011 to 2018 using the North American Association of Central Cancer Registries database. Patients were ages 40 to 64.
The research team compared those who lived in states with expanded Medicaid access -- Louisiana, Kentucky and Arkansas -- to those without in Tennessee, Alabama, Mississippi, Texas and Oklahoma. Oklahoma has since expanded Medicaid access.
Among the more than 21,000 patients, those living in states with expanded access were less likely to be uninsured, 18.9%, compared to 41.1%.
Demographically, patients in states that did not expand access tended to be younger and more likely to be uninsured, Hispanic and live in an urban area with less poverty.
The patients who lived in a state with expanded Medicaid access were less likely to be diagnosed with stage 4 disease. Their odds of being diagnosed with advanced-stage breast cancer decreased by 7% every year after Medicaid was expanded.
One reason for the earlier diagnoses could be increased access to mammograms among low-income patients, the authors said.
Patients had 2.27 times higher odds of receiving treatment for breast cancer just by being diagnosed in a state with expanded access.
Researchers found that even though patients diagnosed in states that expanded Medicaid were more likely to receive treatment overall, the proportion of patients undergoing treatments for their breast cancer decreased in all states.
"This trend raises concern,” said lead author Dr. Amy Laughlin, chief quality officer at the Orlando Health Cancer Institute. “We know from other studies that cancer diagnoses are increasing. If we're then having less treatment received, are we not meeting that demand? That was a surprising finding to me.”
Dr. Katharine Yao, chair of the National Accreditation Program for Breast Centers (NAPBC) of the American College of Surgeons, said future studies may be necessary to understand this trend. Yao was not involved in the study.
“Since Medicaid expansion resulted in a greater than 50% drop in the rate of uninsured for those states that underwent expansion, it seems like a missed opportunity for those states that did not adopt Medicaid expansion," Yao said in the release.
"While observational and only focused on a cohort of patients, this research brings awareness to the widespread disparities in health care in the Southern states and how much further these states have to go before patients receive the health care they need," she said.
Future study could look at whether early detection led to better survival in these states, as well as potential racial or socioeconomic disparities in breast cancer treatment between states that expanded Medicaid and those that didn't.
The U.S. National Cancer Institute has more on invasive breast cancer.
SOURCE: American College of Surgeons, news release, Feb. 1, 2023