U.S. Health Care Reform May Be Raising Rates of Cancer Screening, Early Detection For Women

Two studies show recent improvements in efforts to prevent deaths from breast or cervical cancers

Issue 27 Summer/Fall 2016

woman getting a mammography exam

The Affordable Care Act's efforts at widening access to routine cancer screening may be paying off for women, two studies suggest.

While it's impossible to confirm a cause-and-effect relationship from the studies, each suggests that since so-called "Obamacare" reforms were first enacted in 2010, rates for routine mammography have risen among the poor, and more cervical cancers may have been caught early - potentially saving lives.

One study was released late last year at the annual meeting of the Radiological Society of North America (RSNA). The research was led by Dr. Soudabeh Fazeli Dekhordy, of St. John Providence Hospital in Southfield, Michigan.

Her team notes that as part of the Affordable Care Act (ACA), states were able to widen Medicaid coverage for breast cancer screening - boosting coverage to all American women under the age of 65 who are living at or below 133 percent of the federal poverty level.

By 2011, California, Connecticut, Minnesota, New Jersey and Washington, as well as Washington D.C., had already enacted the new Medicaid rule.

Would this translate to improved rates of breast cancer screening for poorer women?

To find out, Fazeli Dekhordy's team tracked 2008-2012 data from a major federal health survey. They found that by 2012, the percentage of low-income women living in states with expanded Medicaid coverage who had undergone breast cancer screening rose by 25 percent, compared to 2008 levels.

No such improvement in screening rates was observed in states that opted not to expand coverage under the ACA, the researchers said.

Speaking in an RSNA news release, Fazeli Dehkordy said that, "adoption of Medicaid expansion by more states can result in considerable improvement of disparities in breast cancer screening, leading to better health outcomes for all women across the United States."

In a second study, also published late last year, researchers led by Dr. Xuesong Han of the American Cancer Society tracked changes in the rate of detection of early stage cervical cancers for younger U.S. women.

Routine Pap smear tests can spot cervical cancer in women, and guidelines recommend screening beginning at the age of 21.

Han's team notes that in 2010, one of the first ACA reforms to be enacted allowed young adults under the age of 26 to be included on their parents' health insurance plans.

Ideally, that should widen younger women's access to routine cancer screening.

Reporting in the Journal of the American Medical Association, Han and colleagues looked at data from a national cancer database. They focused on data for women ages 21 to 34 who were diagnosed with cervical cancer - both before and after the "dependent-coverage" rule went into effect.

Han's team report that among women aged 21 to 25, the proportion who were diagnosed with an early - and more curable - form of the cancer rose from 68 percent in 2007-2009 to 84 percent by 2011.

The proportion of early cancers detected did drop a bit again by 2012, to 72 percent, Han's team said. However, they believe there's a good explanation for that: In 2011 (the first full year that young adults could get cervical cancer screening under their parents' plans) there may simply have been more early-stage tumors out there to detect.

All of this suggests that, "the dependent coverage expansion has helped young women access preventive services," Han told HealthDay.

She also pointed out that because of another ACA provision, co-pay fees for cervical cancer screening are no longer required.

"So now it's cost-free," Han said. "That removes another potential barrier."