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Colorectal Cancer Screening Increase May Reflect Affordable Care Act Provision

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Key Points

  • Overall colorectal cancer screening increased from 57.3% to 61.2% between 2008 and 2013, mostly in low-income, low-educated, and Medicare-insured individuals.
  • From 2003 to 2008, there was also a colorectal cancer screening increase, but this previous increase was across all socioeconomic measures.
  • Breast cancer screening has not increased between 2008 and 2013, probably due to the lower cost of screening and the existence of women’s health initiatives before the Affordable Care Act.

Screening for colorectal cancer increased in individuals with a lower socioeconomic status after 2008, perhaps reflecting the Affordable Care Act’s removal of financial barriers to screening, according to a new analysis. The study, by American Cancer Society investigators, was published by Fedewa et al in the journal Cancer.

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 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 aged 50 to 75 in the colorectal cancer screening analysis and 14,530 women aged 40 and older in the breast cancer screening analysis.

Analysis Results

Overall, colorectal cancer screening increased from 57.3% to 61.2% between 2008 and 2013. The increase was evident in low-income, low-educated, and Medicare-insured individuals, the population expected to benefit the most from the ACA, but not among groups with a higher socioeconomic status. During the 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 individuals, but that increase was universal across socioeconomic measures. The authors say the findings “may reflect the ACA's removal of financial barriers,” but added it was “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 such as lower cost, 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), and because breast cancer screening prevalence is markedly higher than the corresponding estimate for colorectal cancer screening. 

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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