Abstract PS7-56: The affordable care act and breast cancer stage at presentation at an urban safety net hospital
Authors: Wecsler Julie S , Nagireddy Prathima , Ganschow Pamela S , Marcus Elizabeth 
Published: February 2021

Abstract
Background: The Affordable Care Act (ACA) was signed into law March 31, 2010 and effective from January 1, 2014. Among several key provisions it allowed for expanded access to insurance coverage as well as emphasis upon prevention and wellness. We wanted to examine the impact of the ACA on stage at presentation as well as other demographics on breast cancer patients (pts) diagnosed and/or treated at a large urban public hospital. Methods: We assessed tumor registry data at a large, public safety-net hospital pre-ACA 2012-2014 and post-ACA 2015-2017 in pts with newly diagnosed breast cancer to compare demographics and stage at diagnosis. Medical record abstraction was used to complete demographic and/or stage at diagnosis data for those with incomplete data. Insurance status was obtained from institutional data. Results: A total of 1342 patients were identified that were newly diagnosed with breast cancer between 2012-2017 and had complete data. 899 (67%) of these pts were treated and diagnosed at our hospital, 418 (31%) were diagnosed elsewhere and treated at our hospital, and 25 (2%) were diagnosed at our hospital and treated elsewhere. 658 were diagnosed in the pre-ACA era compared with 684 in the post-ACA era. There were no significant differences in mean age at diagnosis (56 years) or racial distribution of cancers diagnosed between the two groups (44% African American, 28% Hispanic, 16% White, 12% Asian). In the pre-ACA era, distribution of stages at presentation was as follows: Stage 0 (13%), Stage I (24%), Stage II (30%), Stage III (17%), and Stage IV (15%). In the post-ACA era, the stage at diagnoses were Stage 0 (14%) Stage I (26%), Stage II (33%), Stage III (16%), and Stage IV (11%). Only the decrease in the diagnosis of Stage IV cancers in the post-ACA group was statistically significant (p&lt;0.001). Hispanic pts (76%) were more likely to be younger than 60 at time of diagnosis compared with African American pts (56%), White pts (63%) or Asian pts (65%). Younger pts (p&lt;0.001) and African American pts (p&lt;0.002) were more likely to have triple negative disease. Changes in payor status between the 2 cohorts included a 20% increase in pts covered by Medicaid (11% to 31%) and a decrease in self pay (uninsured) status by 11% (56% to 45%). Conclusion: At a public safety net hospital, there was no significant change in the demographics or number of newly diagnosed breast cancers after implementation of the ACA. There was, however, a significant decrease in presentation of stage IV breast cancer at time of diagnosis during the post-ACA era as compared to the pre-ACA era which was offset by small but not statistically significant increases in early stage at diagnosis (Stages 0-2). Over 50% of pts were younger than age 60 at time of diagnosis, regardless of race or ethnicity. This is likely reflective of an overall younger pt population (e.g., age ineligible for Medicare) often cared for at a safety net hospital and may have contributed to a less robust increase in identifying earlier stage cancers in the post-ACA era. Additional factors to consider include expanded access to primary care and cancer screening among newly insured pts who in the pre-ACA era would have presented at a later stage to a public safety net hospital and were now able to seek care earlier at other institutions closer to their home. Further analysis should be done to try to elucidate reasons for this.
Citation Format: Julie S Wecsler, Prathima Nagireddy, Pamela S Ganschow, Elizabeth Marcus. The affordable care act and breast cancer stage at presentation at an urban safety net hospital [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-56.