From the Journals

Consequence of change? Medicaid disenrollment delayed breast cancer diagnosis



A spike in later-stage breast cancers is a potential byproduct of the Republican-proposed Medicaid reductions, according to Wafa Tarazi, PhD, and her colleagues.

The team looked at breast cancer stage at diagnosis following the 2005 Medicaid disenrollment of nearly 170,000 nonelderly adults in Tennessee that occurred because of state financial issues.

“Overall, nonelderly women in Tennessee were diagnosed at later stages of disease and experienced more delays in treatment in the period after disenrollment,” wrote Dr. Tarazi of Virginia Commonwealth University, Richmond, and her colleagues. “Disenrollment was found to be associated with a 3.3 percentage point increase in late stage of disease at the time of diagnosis” (Cancer 2016 June 26. doi: 10.1002/cncr.30771).

The investigators offered a few explanations for why this could be the case.

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“The diagnosis of cancer depends on regular access to preventive services offered by a primary care provider, not an oncologist or a surgeon,” they wrote. “Low-income women who were disenrolled from Medicaid coverage were likely to lose access to preventive services such as mammography screening, which is an important tool for the detection of breast cancer at early stages.”

While disenrollment was associated with later stage of breast cancer at diagnosis, it also was associated with a 1.9 percentage-point decrease in a 60-day–plus delay in surgical treatment and a 1.4 percentage-point decrease in a greater-than-90-day–plus delay in treatment for women living in low-income ZIP codes, compared with women living in high-income ZIP codes.

Contractions “in the availability of Medicaid coverage have important health consequences for low-income women, and may increase income-related disparities, morbidity, and mortality for those diagnosed with breast cancer,” the authors wrote. “These negative health consequences should be considered by policymakers who weigh the costs and benefits of implementing or discontinuing expanded Medicaid coverage under the Patient Protection and Affordable Care Act and future federal and state policies.”

The Susan G. Komen Breast Cancer Foundation funded the study. The authors reported no conflicts of interest.

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