Abstract P2-11-04: Participation in a breast cancer prevention clinic before and after implementation of the Affordable Care Act
Authors: Tinglin Jiliian , Crouse Andrew , Krontiras Helen 
Published: March 2022

Background: Secondary prevention can serve to maintain patients’ long-term health and avoid the costs of chronic disease. At the Preventive Care Program for Women’s Cancer Clinic at UAB (UABPC), multidisciplinary staff provide women at increased risk for breast cancer specialized preventive care via comprehensive risk assessment with resultant recommendations for screening and management strategies. In 2011, several provisions of the Affordable Care Act (ACA) eliminated cost sharing of basic women’s preventive screening programs for patients with non-grandfathered health insurance plans. This increased affordability and accessibility of care for millions of Americans and increased awareness of racial disparities in preventive care. In this study, we examined the potential influence of these provisions on increasing total and minority patient participation in specialized preventive services in the UABPC. Methods: Patients seen in this clinic were consented and data was collected to understand use of preventative services. 2003-2011 was designated as the pre-ACA enactment period and 2011-2019 as the post-ACA enactment period. We further subdivided the patient's first participation in the clinic into 4-year periods to more closely assess trends in total and minority patient participation as a function of ACA implementation. Patients’ age, race, first clinic date, and socioeconomic status (SES) were considered for their impact on uptake of services pre- and post-ACA. Results: Between 2003 and 2019, 2,786 patients were entered into this database. The mean age at first visit was 46.28. 84.3% were White, 13.4% were Black and 2.3% were Asian, Hispanic, Native American, Unknown or of other racial origin. 623 (22.36%) patients were first seen during pre-ACA enactment and 2,163 (77.63%) patients were first seen during post-ACA enactment. From 2003-2011, minority patients comprised 6.4% of clinic patients and between 2011-2019 minority clinic patients nearly tripled to comprise 18.6% of all patients seen. We conducted an overall Chi- Square analysis of patients seen in this clinic by race pre- and post-ACA, demonstrating a significant increase in total and minority patients with a p value&lt;.0001. An overall Chi-Square analysis of patients by race among the aforementioned 4-year time-periods also demonstrated a significant increase in patients between 2007-2011 and 2011-2015 with a p value&lt;.0001. A two-sample t-test determined that the decrease in mean age seen between pre- and post-ACA enactment was not statistically significant. Conclusions: We demonstrate a change in overall uptake of our clinic’s preventive services and specifically changes to the racial makeup of the patient population following the implementation of the ACA. The resultant reduced cost sharing for women’s preventive screening and federal advancement of the Offices of Minority Health are plausible factors in the statistically significant increase in awareness of preventive services and increase in total and minority patient enrollment within the UABPC. These meaningful results underscore the value of federal programs focused on decreasing racial disparities in healthcare and increasing access to preventive care for women at increased risk of breast cancer. Future studies will be needed to determine the specific underlying causes and effects to ensure the greatest impact of future policy changes.

Pre-ACA (N)Post-ACA (N)Race2003-20072007-20112011-20152015-2019White202381856904Black1424155181Asian, Hispanic, Native American, Unknown or Other022839

Citation Format: Jiliian Tinglin, Andrew Crouse, Helen Krontiras. Participation in a breast cancer prevention clinic before and after implementation of the Affordable Care Act [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-11-04.