A study by the American Cancer Society indicates that increased colorectal cancer screening observed in lower socioeconomic status (SES) individuals post-2008 could reflect the Affordable Care Act’s removal of financial restrictions to screening. The research appears online in the journal Cancer.
The Patient Protection and Affordable Care Act (ACA) was created to decrease the financial burden of obtaining preventative services, including colorectal cancer (CRC) and breast cancer (BC) screening. Lead author Stacey Fedewa, of the American Cancer Society and Emory University (both GA, USA), and her colleagues compared CRC and BC screening prevalence among privately and Medicare-insured adults by SES before and after the introduction of the ACA. This was achieved using data from the National Health Interview Survey and included responses from 15,786 adults ages 50–75 years in the CRC screening analysis and 14,530 women age 40 years and older in the BC screening analysis.
Between 2008 and 2013 it was discovered that overall CRC screening rates increased from 57.3 to 61.2% – an increase that was evident in low-income, least-educated, and Medicare-insured individuals. These groups represent the individuals expected to benefit most from the ACA and conversely there was little evidence of increased screening in higher SES groups.
Between 2003 and 2008, before the ACA, a significant increase in CRC screening among privately insured and Medicare-insured individuals was observed. However, this increase was observed across all socioeconomic classes. The authors propose two explanations, saying that the findings: “…may reflect the ACA’s removal of financial barriers,” but also add “it is also possible that these results reflect a continuation of underlying trends in CRC screening in this group.”
No change was observed in BC screening over the same time period. Reasons for this could include fewer barriers because of lower cost and the existence of women’s health initiatives (including the Centers for Disease Control and Prevention’s National Breast and Cervical Cancer Early Detection Program). Breast cancer screening prevalence is also much higher than the corresponding estimate for CRC screening, indicating that there may have been less scope for improvement.