ACA Coverage Expansion Helped Catch Cancer Faster as Insurance Grew

For one cancer, a screening recommendation change hurt results

The percentage of breast cancer cases detected at the earliest stage increased to 48.9% in 2014, from 47.8% in 2013.(Image: Thinkstock) The percentage of breast cancer cases detected at the earliest stage increased to 48.9% in 2014, from 47.8% in 2013.(Image: Thinkstock)

 

(Bloomberg) — The number of Americans whose cancers were diagnosed at the earliest stage, when it’s most likely to be cured, increased after Affordable Care Act coverage expansion programs went into effect and more citizens had access to health insurance, a new study found.

While the effect was small, the study found that a higher proportion of new breast, lung and colorectal tumors were detected at stage 1 in 2014 compared with a year earlier. About 16.4 million Americans gained coverage under the ACA by March 2015 through a combination of private and public insurance, according to a U.S. government analysis.

(Related: 7 States Where More People Get Thyroid Cancer)

The shift to earlier diagnosis, particularly for colorectal and lung cancers, happened primarily in states that expanded access to Medicaid, the insurance program for the poor, according to the study. At the start of 2014, about half of states — largely led by Republican governors or legislatures that opposed the ACA — had opted not to expand Medicaid under the law, according to the Kaiser Family Foundation.

“People without insurance are more likely to be diagnosed at a later stage, especially for the cancers that can be detected early through screening or symptoms,” said lead author Xuesong Han, strategic director of health policy and health care delivery research at the American Cancer Society.

The study is scheduled to be presented at the American Society of Clinical Oncology meeting next month in Chicago. It was funded and conducted by the American Cancer Society, whose political advocacy affiliate, the American Cancer Society Cancer Action Network, was a supporter of the Affordable Care Act and has opposed Republican efforts to repeal it.

Small Increase

The researchers analyzed data from 273,000 patients under age 65, who were diagnosed from 2013 through 2014 with five kinds of cancer that can be detected via screening: breast, lung, colorectal, cervical and prostate tumors. The increases were small, but consistent, showing that for most of the cancers they studied, the rate of early detection increased by about a percentage point.

Here's how the percentage of cancers detected in the earliest stage changed between 2013 and 2014 for five types of cancer:

  • Breast: Increased to 48.9%, from 47.8%.

  • Cervical: Increased to 48.8%, from 47.3%.

  • Lung: Increased to 17.7%, from 16.6%.

  • Colorectal: Increased to 23.7%, from 22.8%.

  • Prostate: Fell to 17.2%, from 18.5%.

“Obviously the changes aren’t enormous,” said Bruce Johnson, chief clinical research officer at Dana-Farber Cancer Institute in Boston who is also the incoming ASCO president. “Because the uptake of screening is relatively slow, this is certainly consistent with the idea that doing the additional screening you could potentially find more stage 1 patients. The earlier the stage, the more likely the person is to be cured.”

The report comes as the Republican-led Congress is working to replace or change the Affordable Care Act. The GOP effort, which is now being considered by the Senate, has been estimated to reduce insurance coverage.

“Whatever form our health care takes over the next several years, we advocate for patients to have early access to screening, which can identify cancers at an earlier stage in more curable forms,” Johnson said.

Oncologists often classify cancers by stage, a measure of how severe a tumor is and whether it has spread through the body. Stage 1 tumors are small and local, and can often be treated by surgery, radiation or drugs. Stage 4 means the cancer has metastasized and spread through the body and are often incurable.

Thousands of Patients

Longer research is needed to determine whether catching the tumors sooner will lead to better survival, according to the researchers. They plan to continue looking at the data to see if the trend continues and shows an improvement in patients’ health.

The information came from the National Cancer Database, a registry of newly diagnosed cancers that picks up about 70% of cases annually. The decrease in prostate cancer detection came after the U.S. Preventive Services Task Force recommended against routinely screening for the disease in 2012.

--- Read Mammogram Proposal Threatens to Reignite Screening Battle on ThinkAdvisor.

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