Women under the age of 65 were more likely to receive early-stage diagnosis and treatment for ovarian cancer after the Affordable Care Act became effective, according to a study released at the 2019 Annual Meeting of the American Society of Clinical Oncology.
There were 2.5% gains in early-stage diagnosis — defined as either stage 1 or stage 2 — and treatment within 30 days of diagnosis in women with public insurance like Medicare and Medicaid after ACA implementation compared to women 65 years and older, according to the study.
Anna Jo Smith, resident at Johns Hopkins Department of Gynecology and Obstetrics and lead study author, said early-stage detection can save patients' lives and lower healthcare costs "compared to treatment of cancer at a more advanced, incurable stage."
Ovarian cancer is the fifth leading cause of cancer death in women, according to the National Institute of Cancer. There is no screening that can detect early-stage forms of cancer and symptoms can go unnoticed for years, according to the study.
The ACA officially took effect in 2010; however, some provisions were implemented years later. According to the study, the U.S. uninsured rate dropped from 16% in 2010 to about 12% in 2016.
Smith said that having health coverage "plays a major role in whether or not a woman has access to care providers who can monitor symptoms and act on those symptoms if necessary."
The research team examined data from the National Cancer Database from two groups of patients between the ages of 21 and 64: Women diagnosed between 2004 and 2009, classified as pre-ACA, and women diagnosed between 2011 and 2014, classified as post-ACA. Both populations were compared to women over the age of 65, which researchers considered to have a higher chance of being insured either pre- or post-ACA due to their access to Medicare, the government-run health insurance program for the elderly.
The researchers adjusted for factors like race, rural demographics, household income and education level.
Overall, there was a 1.7% gain in the early-stage diagnosis of ovarian cancer in 21- to 64-year-old women compared to women 65 and older, the study showed. There was also a 1.6% gain in patients receiving treatment within 30 days of diagnosis in women between 21 and 64 compared to women 65 and older.
According to Smith, the 1.7% gain in early-stage diagnosis is equivalent to about 400 of the 22,000 women who are diagnosed with ovarian cancer every year.
While the study evaluated women diagnosed "post-ACA," the study did not include women diagnosed after 2014, which is when Medicaid expansion went into effect.
Medicaid is the dual state and federally run health insurance program for low-income Americans. The expansion is a provision in the ACA that allows states to increase Medicaid eligibility to individuals who make an income up to 138% of the federal poverty level.
The Kaiser Family Foundation estimates that as of fiscal year 2017, more than 12.6 million people have gained Medicaid coverage since expansion took effect.
The research team plans to study years past 2014 and examine the correlation of ACA implementation with trends in other gynecological cancers.
The 2019 American Society of Clinical Oncology meeting is expected to bring together more than 32,000 professionals from around the world, with more than 2,400 study abstracts to be presented on site and an additional 3,200 abstracts to be published online.