How the ACA impacted breast cancer screening at a safety net hospital

Implementation of the Affordable Care Act (ACA) did not make a significant impact on breast cancer care at a safety net hospital in California, according to findings published in the American Journal of Surgery. The authors noted, however, that more patients did have health insurance in the two years following implementation.

The authors examined data from breast cancer patients treated at the safety net hospital for two years before the ACA (2011-2012) was in place and two years after the ACA (2015-2016). In California, ACA implementation led to an expansion of the state’s Medicaid program, Medi-Cal.

While 310 patients were diagnosed with breast cancer at the institution in 2011-2012, 18 were excluded, leaving a total of 292 for analysis. Also, 203 patients were diagnosed with breast cancer in 2015-2016 with 17 excluded, leaving 186 for analysis. No differences were observed in the absolute number of screening mammograms performed at the hospital during the two timeframes. The average age of patients at the time of diagnosis was just one year apart—53 years old before the ACA and 54 years old after the ACA—which the authors said was an insignificant difference. In addition, there was no difference in the overall clinical stage at diagnosis.

“In spite of the goal of the ACA to increase access to care, we found that, at a safety net hospital, there was instead a significant decrease in breast cancer cases treated in the years following ACA implementation, with no detectable impact on mammographic screening services,” wrote author Vikas Satyananda, MD, of the department of surgery at Harbor-UCLA Medical Center in Torrance, California, and colleagues. “These findings are, perhaps, not unexpected, as we can hypothesize that there may have been an increase in the number of patients who were able to obtain non-Medi-Cal insurance and seek care elsewhere.” 

The authors said it was “surprising to find the manner of presentation and stage of diagnosis did not improve,” but also referenced recent research that found Medi-Cal patients are more likely to present with advanced disease than other patients.

“This is due to a multitude of reasons, including access to care with limited resources, cultural perception of cancer, and lack of education and awareness,” the authors wrote. “We remain hopeful that, over time, this trend of advanced stage diagnoses will begin to reverse as access to care increases.”

Satyananda and colleagues also noted that many more patients had health insurance following ACA implementation. In the patient group before the ACA, 34 percent of patients fell under the “self pay/not insured” category. After the ACA had been implemented, that number dropped to just 6 percent of patients.