Kirkpatrick Dan, Dunn Margaret, Tuttle Rebecca
From the *Department of Surgery, Boonschoft School of Medicine, Wright State University, Dayton, Ohio; and.
Am Surg. 2020 Mar 1;86(3):195-199.
Patients presenting with localized breast cancer have a five-year survival of 99 per cent, whereas survival falls to 27 per cent in advanced disease. This obviates the importance of early diagnosis and treatment. Our study evaluates the impact of Ohio's Medicaid expansion and the passage of the Affordable Care Act (ACA) on the stage at which Ohioans were diagnosed with breast cancer. Data were collected for 3056 patients presenting with breast cancer between 2006 and 2016 in the Dayton area. Patients were divided into groups based on cancer stage. The percentage of patients presenting with advanced disease (stage 3 or 4) was compared both before and after ACA implementation and Ohio Medicaid expansion. These results were also compared with statewide data maintained by the Ohio Department of Health. Compared with pre-ACA, the number of uninsured patients post-ACA was noted to fall 83 per cent, the number of patients presenting with Medicaid increased by five times, and the proportion of patients younger than 65 years presenting with breast cancer increased by approximately 7 per cent. These changes notwithstanding, no difference was identified in the percentage of patients presenting with advanced breast cancer before and after ACA implementation or Ohio Medicaid expansion ( = 0.56). Statewide data similarly demonstrated no change ( = 0.88). Improved insurance access had a smaller-than-anticipated impact on the stage at which Ohioans presented with breast cancer. As significant morbidity and mortality can be avoided by earlier presentation, additional research is appropriate to identify factors affecting patients' decision to seek breast cancer screening and care.
患有局限性乳腺癌的患者五年生存率为99%，而晚期疾病患者的生存率则降至27%。这凸显了早期诊断和治疗的重要性。我们的研究评估了俄亥俄州医疗补助扩大以及《平价医疗法案》（ACA）的通过对俄亥俄州居民被诊断出乳腺癌时的分期的影响。收集了2006年至2016年期间代顿地区3056例乳腺癌患者的数据。患者根据癌症分期分组。比较了ACA实施和俄亥俄州医疗补助扩大前后晚期疾病（3期或4期）患者的百分比。这些结果还与俄亥俄州卫生部保存的全州数据进行了比较。与ACA实施前相比，ACA实施后未参保患者数量下降了83%，参加医疗补助的患者数量增加了五倍，65岁以下患乳腺癌的患者比例增加了约7%。尽管有这些变化，但在ACA实施或俄亥俄州医疗补助扩大前后，晚期乳腺癌患者的百分比没有差异（P = 0.56）。全州数据同样显示没有变化（P = 0.88）。保险可及性的改善对俄亥俄州居民患乳腺癌时的分期影响小于预期。由于更早就诊可避免显著的发病率和死亡率，因此进行更多研究以确定影响患者寻求乳腺癌筛查和治疗决策的因素是合适的。
