Utility of Medicaid Expansion of Health Outcomes in Female Breast Cancer Patients: Scoping Review

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Per the CDC breast cancer is the second most prevalent cancer type for women in the United States, where an estimated 1:4 women are diagnosed, and 1:8 women die each year from it, despite a 90% survival rate at all stages combined. Access to care is at the core of survival from breast cancer, making having insurance vital to initiate the ideal healthcare pathway. On January 1, 2014 the United States federal government made Medicaid expansion (ME) available for participating states. This paper attempts to examine Medicaid Expansion as an intervention, and its influence on breast cancer outcomes along various phases encapsulating detection and treatment outcomes of the disease.

Study Design:
Scientific primary literature studies between 2012 and 2023 meeting inclusion criteria listed within the article were pulled to examine the influence of Medicaid Expansion between Medicaid expanded states (MES) and Non-Medicaid Expanded States (NMES)on outcomes such as access, screening, time to treatment, and staging and survival.

Access: More Breast Cancer patients were covered by Medicaid post Medicaid expansions vs. Pre-expansion. Moss et el: Significant decrease in rate of uninsured, with corresponding increase in Medicaid insured patients (p<0.001). Martinez et el: Uninsured women decreased by 0.3 percentage points, while women with Medicaid increased by 2.4 percentage points. Laughlin et el: Uninsured in Medicaid Expanded States vs. Non-Medicaid expanded states were 18.9%, 41.1% respectively p<0.0001. Toyoda et el: 2011, 87.5% of the population within expanded states, and 86.7% within non-expanded states were insured, and rose to 94.9% and 91.3 percent respectively by 2016. Screening: Increased access pre-vs. Post Medicaid Expansion suggests improvement in participation of Breast Cancer Screening towards certain population groups. Toyoda et el: the overall rate of screening mammograms among 50 to 74 year old women in expanded states was 77.3% in 2010 and 80.0% in 2018. Wright et el: Despite overall nonsignificant findings between MES and NMES post ME for Mammogram Screening, significant findings of a 3.3 percentage point increase in past 2 year mammogram was found among women aged 50-64 years old under 138% of the Federal Poverty Guideline (95%CI = 0.4,6.3).. Friedmann et el: Significant 3.3 percentage point increase in past-2-year mammogram and 5-year mammograms pre vs. post ME (95% CI=0.4, 6.3). Time to Treatment: Increased proportion of women under-going breast conservation therapy (P<0.001), Time from operation to chemotherapy remained unchanged (p=0.26), Time from operation to radiation decreased (p<0.001), Diagnosis to operation time increase (p<0.001) Bhutiani et el: 35.78% delay from diagnosis to surgery p=0.0143, 20.16% delay from surgery to post-operative chemotherapy p=0.0012, 3.86% a delay form surgery to post-operative radiation, p = 0.0026. Staging| Survival: Leblanc et el.:In MES, patients <50 y/o saw reductions in advanced disease post-ME vs. pre-ME, 20.7%, 22.9% respectively p<0.001. Semprini et el: Black/white mortality ratio increased in states expanding Medicaid for all Medicaid-eligible age groups with significant effects in younger age groups. p= 0.01 to 0.15. Ji X et el: Increase in overall 2-year survival among patients with breast cancer with influence of ME (P=0.011).

Despite mixed findings, studies suggest that patients who rely on Medicaid have other socioeconomic and cultural barriers in addition to problems with access to care.



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