Medicaid cuts linked to later breast cancer diagnosis

(Reuters Health) - More women may be diagnosed with advanced breast cancer and suffer treatment delays when Medicaid cutbacks eliminate coverage for many adults with low-income jobs, a study in Tennessee suggests.

In 2005, nearly 170,000 people lost their medical insurance after cuts to TennCare, the state’s Medicaid program. For the new study, researchers compared data from before and after that year, to see how long it took to diagnose and treat breast cancer in women living in low-income versus high-income zip codes in Tennessee.

In low-income areas, where more residents were insured through Medicaid, the proportion of breast cancer cases diagnosed at a late stage when tumors had spread rose from 35.4 percent in 2002-2004 – before the Medicaid cuts – to 40.2 percent in 2006-2008, researchers note in the journal Cancer.

“When women lose access to health insurance, they may be less likely to receive recommended mammograms and have access to regular primary care services that would facilitate an early diagnosis of cancer,” said senior study author Lindsay Sabik, a public health researcher at the University of Pittsburgh.

“A growing body of evidence shows that health insurance coverage, and Medicaid in particular, is associated with having a usual source of health care, access to primary care, and use of preventive services,” Sabik said by email.

The majority of the women in the study were white, married and insured.

Researchers defined low-income zip codes as areas where at least half the residents had annual income of no more than $38,700 in 2005, equivalent to 200 percent of the federal poverty level for a family of four. In high-income zip codes, half of the people made more than that each year.

In the high-income areas, the proportion of breast cancer cases diagnosed at a late stage increased from 34.6 percent before the 2005 Medicaid cuts to 36.2 percent afterward, the study found.

There was a 3.3 percentage point increase in late-stage diagnosis for women living in low-income zip codes relative to women living in high-income zip codes.

Both in poorer and more affluent areas, women were more likely to experience surgery and treatment delays after the Medicaid cuts, but the change was more pronounced in high-income zip codes.

The proportion of women who waited more than 60 days for surgery after their diagnosis rose from 12 percent before the cuts to 14.3 percent afterward in low-income areas, while it increased from 10.2 percent to 14.4 percent in high-income zip codes.

Limitations of the study include the lack of data on whether diagnosis and treatment delays translated into worse survival odds for women with breast cancer and the lack of data on how many women in the study actually lost Medicaid benefits as a result of the 2005 cuts, the authors note.

Still, the results have implications for other states considering Medicaid cuts, because treatment and diagnosis delays can make treatment more difficult and more expensive, the researchers argue.

Federal and state lawmakers are considering rollbacks of Medicaid expansions implemented under the Affordable Care Act, also known as Obamacare, to save money or address fiscal shortfalls, Sujha Subramanian, a health economics and policy researcher at RTI International in Waltham, Massachusetts, writes in an accompanying editorial.

“Losing Medicaid coverage will have detrimental impact on cancer patients,” Subramanian said by email.

Survival odds are worse with later diagnosis, Subramanian said. When breast cancer is caught early, before tumors have spread, 98.9 percent of patients survive five years after diagnosis, but this drops to only 26.9 percent when malignancies have spread far beyond the breast.

Costs may keep some women from getting symptoms like a lump in their breast checked out, Subramanian added.

“Affordability is a huge issue and even if women realize they are experiencing potential breast cancer symptoms, they will delay seeking care as they may not have the funds required to pay for the diagnostic procedures,” Subramanian added. “In addition, providers generally charge higher fees for those without insurance coverage.”

SOURCE: Cancer, online June 26, 2017.