Screening for colorectal cancer (CRC) increased in lower socioeconomic status persons after 2008, perhaps reflecting the Affordable Care Act’s removal of financial barriers to screening. This new analysis appeared online in the journal Cancer (2015; doi:10.1002/cncr.29494).
The Patient Protection and Affordable Care Act (ACA) included a cost-sharing provision intended to reduce financial barriers for preventive services, including screening for colorectal cancer and breast cancer.
To investigate whether that provision has affected screening rates, researchers from the American Cancer Society, led by Stacey Fedewa, MPH, used data from the National Health Interview Survey to compare colorectal cancer and breast cancer screening prevalence among privately and Medicare-insured adults by socioeconomic status before and after the ACA. They included responses from 15,786 adults ages 50 to 75 years in the colorectal cancer screening analysis and 14,530 women age 40 years and older in the breast cancer screening analysis.
Overall, CRC screening increased from 57.3% to 61.2% between 2008 and 2013. The increase was evident in low-income, least-educated, and Medicare-insured persons, the population expected to benefit the most from the ACA, but not among higher socioeconomic status groups. During the previous 5-year period (between 2003 and 2008, before the ACA), there was also a significant increase in colorectal cancer screening among privately insured and Medicare-insured persons, but that increase was universal across socioeconomic measures.
The authors said the findings “may reflect the ACA’s removal of financial barriers.” They added, “It is also possible that these results reflect a continuation of underlying trends in colorectal cancer screening in this group.”
Screening for breast cancer remained unchanged during that time period, perhaps due to fewer barriers because of lower cost and the existence of women’s health initiatives (such as the Centers for Disease Control and Prevention’s National Breast and Cervical Cancer Early Detection Program). Also, breast cancer screening prevalence is markedly higher than the corresponding estimate for colorectal cancer screening, so it may have less room for improvement.