A weapon against breast cancer

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Finding a lump in your breast is scary. Worse is learning it’s an advanced cancer. Worse still: being uninsured when this calamity strikes.

A new study indicates that that scenario is less likely in states that expanded Medicaid under Obamacare than in states that didn’t. A team led by Tristen Park, an assistant professor of surgery at Yale, analyzed records of nearly 1.8 million women in the National Cancer Database. They assessed a patient’s breast cancer stage at diagnosis—and her insurance. They also compared the numbers of uninsured patients in Medicaid before and after expansion.

Their conclusion: expanding Medicaid may encourage a patient who finds a lump to consult a doctor earlier. In expansion states, diagnoses of advanced cancer fell by 2.5 percent overall—after just two years. Among Black women, it fell by 3 percent. (There was less change in non-expansion states.) “We could see small but concrete, statistically significant improvements,” Park says. The study is online in JAMA Surgery.

But, Park notes, some states had very high uninsured rates; “concomitantly, their patients are diagnosed with a very high rate of very advanced cancers.” By the time breast cancer is obvious, it’s often in a late stage, harder to treat. In some non-expansion states, an uninsured woman is eligible for Medicaid only if she makes under $4,996 a year. Park says many women can’t afford a mammogram or treatment. A pea-sized lump and no money, she adds, may lead one to think, “I’ll take care of it later—it’s probably nothing.”