Early data from Medicaid expansion in Kentucky since the passage of the Affordable Care Act (ACA) shows improvements in the quality of breast cancer care, including the diagnosis of early-stage disease and greater use of breast-conserving surgery, according to research published online February 12 in the Journal of the American College of Surgeons.
A team led by Dr. Hiram Polk Jr. from the University of Louisville used information from the Kentucky Cancer Registry for all women ages 20 to 64 who were diagnosed with breast cancer between 2011 and 2016. The number of screening mammograms covered by Medicaid increased from 5.6% before expansion to 14.7% after, and the number of women who had screening mammograms and were uninsured declined from 53% before expansion to 5% after, the researchers found.
Breast cancer incidence and treatment rates did not vary significantly from year to year, but the researchers did find statistically significant changes in the rates of early-stage versus late-stage disease treated in the pre- and post-Medicaid expansion periods. Rates of breast-conserving surgery also increased after Kentucky expanded its Medicaid program in 2014.
| Breast care measures pre- and post-Medicaid expansion in Kentucky | ||
| Before expansion | After expansion | |
| No. of mammograms covered by Medicaid | 5.6% | 14.7% |
| No. of women who underwent screening mammograms who were uninsured | 53% | 5% |
| Early-stage cancers identified | 64.5% | 66.7% |
| Late-stage cancers identified | 15% | 12.9% |
| Rates of breast-conserving surgery | 44% | 48.8% |
| Rates of other types of surgical treatment, including mastectomy | 50.5% | 44.5% |
The findings corroborate those of other state experiences with either expansion or contraction of Medicaid programs, but a thorough analysis of the Medicaid expansion in Kentucky requires longer-term study, Polk said in a statement released by the American College of Surgeons.
