State’s first to embrace Medicaid expansion saw gains in colorectal cancer screening

The five first states to expand Medicaid experienced increases in colorectal cancer (CRC) screening compared to those that did not, according to a new study published in the American Journal of Preventative Medicine. Washington D.C. also had similar results after its own expansion.

If the non-expansion states had seen such increases in CRC screening, another 355,184 people would have been screened, according to first author Stacey A. Fedewa, PhD, of surveillance and health services research, American Cancer Society in Atlanta, and colleagues.

In order to better understand how Medicaid expansion impacted cancer screening, Fedewa et al. looked at temporal changes in screening patterns among low-income adults in all states among data from the 2012, 2014 and 2016 Behavioral Risk Factor Surveillance System (BRFSS), a state-based phone survey conducted by the CDC.

The respondents were grouped according to Medicaid expansion timing: six states were very early (VE), expanding March 1, 2010- April 14, 2011; 21 were early, considered January 1, 2014-August 15, 2014; five late states which expanded January 1, 2015-July 1, 2016; the remaining 19 were non-expansion states.

Results showed that between 2012 and 2016, low-income adults ages 50 to 64 who were current with their CRC screening jumped by 8.8 percentage points in VE states and by 3.8 percentage points in non-expansion states. Additionally, those considered recently screened for CRC (colonoscopy, stool testing or sigmoidoscopy in the past two years) increased from 30.1% to 38.1% in VE states compared to a jump in 2.8 percentage points in non-expansion states.

This jump in CRC screening seen in very early adopting states equated to an additional 236,573 low-income adults receiving screening in 2016. If that same increase had occurred in non-expansion states another 355,184 low-income adults would have been screened for CRC.

"Health insurance is a strong predictor of cancer screening, and the uninsured and those with lower socioeconomic status are more likely to be diagnosed at late stage and die from screen-detectable cancers, including colorectal cancer," Fedewa said in a news release from the American Cancer Society.

Fedewa and colleagues also found breast cancer screening increased “modestly” in low-income women who lived in expansion states.

One important takeaway from the study is that change is not immediate and it takes time for screening to numbers to increase after Medicaid expansion is adopted. This may be due to a “lag time” between people becoming insured and finishing the often long process to complete CRC screening, the authors noted.

"It is likely that the full impact of Medicaid expansions on cancer screening may not yet be fully visible and the previously reported modest improvements in early stage at diagnosis for screen detectable cancers could progress further," Fedewa said in the same release.