Under ACA, more breast cancers diagnosed at early stages, racial disparities lessened

After the Affordable Care Act was enacted, the number of breast cancers diagnosed in Stage I increased, and were higher among African American and Latina women compared with Caucasian women, according to a study by researchers at Loyola University Chicago, Chicago, IL. Their results are published in the journal Cancer Epidemiology.

Beginning on January 1, 2011, the ACA eliminated copayments for mammography and other recommended preventive services with a preventive services provision (PSP). Researchers used data from the National Cancer Database to assess the impact of this provision on breast cancer stage and racial and ethnic differences in stage at diagnosis. This database includes about 70% of all newly diagnosed cancer in the United States from 1,500 hospitals.

For their retrospective study, researchers included 470,465 breast cancer patients aged 50 to 74 years covered by private insurance or Medicare and newly diagnosed with Stage I-IV cancer. They identified the pre-PSP period as 2007 to 2009, and the post-PSP period as 2011 to 2013, and calculated proportion differences (PDs).

Researchers observed a 3.6 percentage point increase in the percentage of breast cancer diagnosed at Stage I (from 54.4% to 58.0%), with a corresponding decrease in both Stage II and Stage III diagnoses, but no change in the incidence of Stage IV diagnoses.

This shift to Stage I diagnoses increased by 3.2 percentage points in Caucasian women, 4.0 percentage points in African American women, and 4.1 percentage points in Latina women.

They found a statistically significant shift toward Stage I breast cancer in all three racial/ethnic groups. In the pre-PSP period, the disparity between African American and Caucasians in Stage I cancer was -9.5 (95% CI: -8.9, -10.4), while the Latina:Caucasian disparity was -5.2 (95% CI: -4.0, -6.1). In the post-PSP period, these disparities had slightly improved.

“Preliminary data suggest that the ACA's PSP may have a meaningful impact on cancer stage overall and by race/ethnicity. However, more time may be needed to see reductions in disparities,” concluded the authors.

This study was supported by grants from the National Institutes of Health and the Avon Foundation.