In a study reported in JAMA Surgery, Le Blanc et al found that Medicaid expansion under the Affordable Care Act was associated with increased insurance coverage and reduction in rates of diagnosis of breast cancer at later stages.
The study involved data from the National Cancer Database on patients with primary breast cancer who had private insurance, Medicare, Medicaid, or were uninsured across 45 states.
The effect of Medicaid expansion in 2014 was assessed by comparing rates of insurance coverage and rates of breast cancer diagnosis at later stages (stage III and IV) in the preexpansion period of 2012 to 2013 vs the postexpansion period of 2015 to 2016.
In the preexpansion vs postexpansion periods among all patients, the proportion of uninsured patients was reduced from 22.6% to 13.5% (P < .001) in states that expanded Medicaid. The proportion was reduced from 36.5% to 35.6% (P = .12) in nonexpansion states.
Among all patients, there was a reduction in diagnosis at advanced-stage disease from 21.8% to 19.3% (P < .001) in expansion states, with a reduction from 24.2% to 23.5% (P = .14) in nonexpansion states.
Among black patients, diagnosis at advanced-stage disease was reduced from 24.6% to 21.6% (P < .001) in expansion states, whereas there was no change in nonexpansion states (27.4% vs 27.5%, P = .94).
Among patients younger than 50, diagnosis at advanced-stage disease was reduced from 22.9% to 20.7% (P < .001) in expansion states, whereas no significant change was observed in nonexpansion states (25.7% vs 26.5%, P = .64). Among patients 50 and older, diagnosis at advanced-stage disease was reduced from 21.3% to 18.8% (P < .001) in expansion states and from 23.3% to 21.5% (P < .006) in nonexpansion states.
The reductions observed in diagnosis at later stages of disease appeared to largely reflect a reduction in diagnosis of stage III disease.
The investigators concluded, “In this cohort study, expansion of Medicaid was associated with a reduced number of uninsured patients and a reduced incidence of advanced-stage breast cancer. [Black] patients and patients younger than 50…experienced particular benefit. These data suggest that increasing access to health-care resources may alter the distribution of breast cancer stage at diagnosis.”
Tristen S. Park, MD, of the Department of Surgery, Yale University School of Medicine, is the corresponding author for the JAMA Surgery article.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.