Trends in breast and colorectal cancer screening among U.S. adults by race, healthcare coverage, and SES before, during, and after the great recession

Abstract

The aim of this study is examine trends in breast and colorectal cancer screening in the U.S. by race, healthcare coverage, and socio-economic status (SES) before the Great Recession (2003–2005), during the recession (2007–2009), and post-recession/Affordable Care Act (ACA) period (2010 − 2012). Data on a representative sample of U.S. adults was obtained from the Behavioral Risk Factor Surveillance System (BRFSS). Breast and colorectal cancer screening were defined in line with U.S. Preventative Services Task Force guidelines, and survey weighted statistical methods were utilized to analyze trends in cancer screening among 1,858,572 BRFSS participants. Overall, 83% of women received mammograms in the past 2 years, while 95% of adults received colorectal cancer screening in the past 10 years. Compared with the pre-recession period, the odds of colorectal screening within 5 years were slightly higher during the recession (OR: 1.05, 95% CI: 1.03–1.08) but significantly lower in the post-recession/ACA period (OR: 0.73, 95% CI: 0.72–0.75). Odds of mammography screening were lower during (OR: 0.94,95% CI: 0.91–0.96) and post-recession/ACA period (OR: 0.80, 95% CI: 0.78–0.82). Breast cancer screening rates declined in the recession and post-recession, while colorectal cancer screening rates increased during the recession and decreased post-recession. Low SES adults and those without healthcare coverage were the least likely to receive screening.

Medicaid Expansion and Breast Cancer Screening in Appalachia and Non-Appalachia, United States, BRFSS 2003 to 2015

“…3,26,33-40 Similar to our findings, other studies have observed significant reductions in breast cancer screening in the post-expansion period. 26,34-36,39 Two US studies 26,36 found a 13% 26 and 20% 36 reduced odds of breast cancer screening in the post-expansion period among women aged 50 to 74 years. We observed that in non-expanded Appalachia states, women aged 50 to 59 years had marginally higher screening in both the pre- and post-expansion periods.…”

“…Future studies are needed to better target these disparate populations and address barriers to health-care access. Fourth, while self-reported measures of women’s cancer screening in the BRFSS have been validated 47,48 as we and others have shown that 34 -37,39 self-reported measures of breast cancer screening are subject to recall bias 49 resulting in misclassification, with a significant proportion of participants overreporting screening practices. Data using objective measures of screening from claims data across Medicaid expansion and Appalachia states may be necessary to definitively estimate the impact of the ACA on breast cancer screening in the United States.…”

Utilization of a Colorectal Cancer Screening Test Among Individuals With Average Risk

“…However, despite the established benefits of CRC screening, 2,3 screening rates in the United States remain below the National Colorectal Cancer Roundtable goal of 80%. [4][5][6][7] National organizations, such as the United States Preventive Services Task Force (USPSTF), the National Comprehensive Cancer Network, and Multi-Society Task Force, endorse several test options for CRC screening for individuals with average risk beginning at age 50 years, while the 2018 American Cancer Society (ACS) guidelines have a qualified recommendation that individuals with average risk start CRC screening at age 45 years. [8][9][10][11] CRC test options include high-sensitivity fecal occult blood test (FOBT), fecal immunochemical test (FIT), multitarget stool DNA assay (mt-sDNA; marketed as Cologuard [Exact Sciences, Madison, WI]), computed tomography (CT) colonography, flexible sigmoidoscopy, or colonoscopy.…”

“…Encouragingly, CRC incidence and mortality rates in the United States have decreased by 1% to 2% per year between 2007 and 2016, likely attributable to increased participation in screening. However, despite the established benefits of CRC screening, screening rates in the United States remain below the National Colorectal Cancer Roundtable goal of 80% …”

Race/ethnicity, sex and insurance disparities in colorectal cancer screening among individuals with and without cardiovascular disease

“…This may have been alleviated with enactment and uptake of the Affordable Care Act (ACA) and it is expected that the health insurance status of individuals with and without CVD may have changed ( Kominski et al, 2017 ). Wyatt et al demonstrated there was an uptick in CRC screening in the immediate post-ACA period of 2010–2012 ( Wyatt et al, 2017 ). However, there is little evidence in the existing literature about the relationship(s) between racial/ethnic or sex disparities and the prevalence of CRC screening in the post ACA enactment.…”