Uptick in Early-Stage Breast Cancer Diagnoses Seen Among Minority Women Following ACA Implementation

Study results show there was an increase in diagnoses of early-stage breast cancer among younger vs older minority women when comparing the 3-year period before implementation of the Affordable Care Act (ACA) with the 3-year period after, reports Journal of Women’s Health.

“The ACA expanded access to affordable insurance coverage, making it possible for more women to undergo regular breast cancer screening. This study demonstrates the benefits that this can have for early breast cancer diagnosis and the ability to begin to mitigate some of the racial disparities in early detection," said Journal of Women's Health Editor-in-Chief Susan G. Kornstein, MD, executive director of the Virginia Commonwealth University Institute for Women's Health, Richmond, Virginia, in a statement.

Outcomes were analyzed among 2 groups of women—aged 50 to 64 and 68 to 74 years—accounting for 35,735 cases of breast cancer:

• Women 50-64 years:
  • 14,679 cases before the ACA
  • 11,063 cases after
• Women 68-74 years:
  • 5364 cases before the ACA
  • 4629 cases after

The Pennsylvania Cancer Registry provided the data, and all study participants received their diagnosis in the state between 2010 and 2016. Data were analyzed from January to October 2019. In addition, outcomes among the younger group were investigated according to race/ethnicity, area of residence, and socioeconomic status per area deprivation index (ADI) using multivariable logistic regression analysis. ADI was divided into quartiles, based on Census tract of residence, with quartile 4 indicating the most disadvantaged (least advantaged).

There was an overall 1.71% increase in early-stage (stage 0-II) breast cancer diagnoses among the women aged 50 to 64 years, from 86.05% before the ACA to 87.76% after (P < .01), but no change seen in the women aged 68 to 74 years (88.14% vs 88.55%, respectively; P = .53).

“Despite improvements in breast cancer screening and treatment for Americans overall, disparities in breast cancer and cancer care, in general, related to race, socioeconomic status, and area of residence are a persistent challenge,” the authors noted. “For instance, black women more commonly present with advanced disease and have a higher breast cancer-specific mortality compared to white women, despite similar breast cancer incidence.”

A similar improvement when analyzing the contributory effect of socioeconomic status was not seen. Women who lived in areas with a socioeconomic advantage had consistently higher odds of an early-stage diagnosis both before and after the ACA, regardless of race, area of residence, or primary care physician density.

More women in the study who were aged 68 to 74 years were non-Hispanic White compared with the women aged 50 to 64 years. However, “patients were distributed similarly by race and area of residence pre- and post-ACA,” the authors noted.

Analyses produced these results when comparing the pre- and post ACA periods:

• The percentage of minority women aged 50 to 64 years who received a diagnosis of early-stage breast cancer increased from 83.12% to 85.83% (P = .02).
• The percentage of non-Hispanic White women aged 50 to 64 years who received an early-stage diagnosis increased from 86.54% to 88.09% (P < .01), respectively.
• Women living in an urban location saw more early-stage diagnoses compared with those who had a nonurban residence: 86.03% vs 87.95% (P < .01) and 86.21% vs 86.36% (P = .91), respectively.
• Those living in ADI quartiles 1 and 2 saw more early breast cancer diagnoses:
  • ADI Q1: 88.67% vs 90.68% (P < .01)
  • ADI Q2: 85.79% vs 88.24% (P < .01)

“While our study suggests that the ACA has had a positive impact on breast cancer diagnosis in Pennsylvania, questions remain,” the authors concluded. “Advances in screening mammography and treatment have improved breast cancer-related mortality, but disparities in breast cancer care, and cancer care in general, persist due to multiple factors for which multilevel intervention is needed.”

Their suggestions for future research include identifying why health care disparities continue to affect certain populations more than others and investigating the impact of social determinants of health on health care access and outcomes.

Reference

Spada NG, Geramita EM, Zamanian M, van Londen NG, Zhaojun S, Sabik LM. Changes in disparities in stage of breast cancer diagnosis in Pennsylvania after the Affordable Care Act. J Womens Health (Larchmt). Published online September 28, 2020. doi:10.1089/jwh.2020.8478