By Robert Preidt
"Health insurance is a strong predictor of cancer screening, and the uninsured and those with lower socioeconomic status are more likely to be diagnosed at late stage and die from screen-detectable cancers, including colorectal cancer," study leader Stacey Fedewa said in an American Cancer Society news release. Fedewa is senior principal scientist for the society's Surveillance and Health Services Research.
The Affordable Care Act let states expand Medicaid insurance coverage to low-income adults, who tend to have poor access to preventive health services.
Five states and the District of Columbia were very early adopters and expanded Medicaid eligibility in 2010-2011. Another 21 states expanded Medicaid in 2014, five states expanded in 2015-2016, and 19 states did not expand.
American Cancer Society researchers analyzed data from the U.S. Centers for Disease Control and Prevention and found that in states that were very early adopters of the expansion, the rate of low-income adults ages 50-64 who were up to date with colon cancer screening rose from 42.3% in 2012 to 51.1% in 2016.
Rates increased from 49.6% to 52.5% in states that expanded Medicaid between 2014 and 2016, and from 44.2% to 48% in non-expansion states.
Rates of recent colon cancer screening (in the past two years) increased from 30.1% to 38.1% in very early adopters and from 29.1% to 31.8% in non-expansion states.
The increase in screening rates in very early adopters led to nearly 236,600 additional low-income adults with recent colon cancer screening in 2016.
If the same increase had occurred in non-expansion states, more than 355,000 more low-income adults would have had recent colon cancer screening, according to Fedewa and her colleagues.
The report also found that breast cancer screening increased only modestly among low-income women in the states that expanded Medicaid coverage.
But the authors say that there is more widespread support for mammography in low-income populations through programs like the CDC's National Breast and Cervical Cancer Early Detection Program, as well as programs offered by nonprofits and mobile mammography clinics.
Also, they added, mammography is cheaper and requires less preparation than colon cancer tests.
The study was published online May 22 in the American Journal of Preventive Medicine.