Abstract P5-13-03: The effect of the affordable care act on the initial stage of presentation of breast cancer in a safety-net hospital
Authors: Sandoval Leon AC , Ghanta S , Richardson A , Kesmodel S , Hurley J 
Published: May 2019

Abstract
Background: There are disparities in breast cancer (BC) diagnosis. Black and Hispanic women have a lower rate of screening mammography while the uninsured are less likely to seek medical care even if a palpable mass is found in the breast.
Jackson Memorial Hospital is the Safety-Net Hospital that serves the 2.5 million residents of Miami-Dade County which is the most populous county in the State of Florida. The Affordable Care Act (ACA) was signed into law on March 3, 2010 and the goal was to increase the number of insured individuals. In January 2011, it was mandated that health insurance providers cover the cost of screening mammograms. The decision to expand Medicaid was left to the individual states. Florida did not expand Medicaid coverage. Prior to the implementation of the ACA it was estimated that 25-35% of the residents of Miami-Dade County were uninsured or underinsured. By January 2017, more than 1.3 million Floridians had signed up for health insurance through the ACA. Currently almost one in five Americans receiving health coverage via Healthcare.gov or the Spanish language version, CuidadodeSalud.gov, resides in Florida. South Florida is home to the eight congressional districts with the highest concentrations of ACA enrollees in the US. The top 38 zip codes for ACA sign-ups in Florida are in South Florida.
We postulated that evaluating the number of patients diagnosed, the stage at which they are diagnosed and the type of insurance used for the period of time 6 years before (2007-2012) and 4 years after the implementation of the ACA (2014-2017) should give a picture of the effect of the ACA on breast cancer diagnosis in an underserved population.
Methods: A retrospective review of patients diagnosed with invasive and in situ breast cancer at the Breast Diagnostic Center at Jackson Memorial Hospital between 1/1/2007 – 12/31/2017 was approved by the University of Miami IRB. We collected data including: age, stage at diagnosis and type of insurance. In keeping with other similar studies, the year 2013 was excluded since it was a transition period. The trends were compared using ANOVA and chi-squared tests.
Results: A total of 2155 patients were analyzed. The absolute number of patients with stage 0 seen every year remained stable (30 per year) throughout the time period. The percentage of patients with Stage 0 increased from 12.5% to 16.02% (p=0.049).Both the absolute number and percentage of patients with stage IV decreased, from 15 to 8 patients per year (6.42% to 4.12% (p=0.016)). The total number of patients diagnosed yearly with breast cancer decreased from 233 to 186 (p= 0.005). The absolute number and percentage of insured patients increased from 75 to 126 patients per year (23.5% to 38.3% (p= 0.02)).
Conclusions: Fewer patients were diagnosed with breast cancer at the safety net hospital in Miami-Dade County after the initiation of the ACA. More patients had insurance and there was a stage shift towards lower stage at presentation. Availability of insurance to residents of Miami-Dade County decreased the burden on the safety net hospital and resulted in the diagnosis of lower stage breast cancer.
Citation Format: Sandoval Leon AC, Ghanta S, Richardson A, Kesmodel S, Hurley J. The effect of the affordable care act on the initial stage of presentation of breast cancer in a safety-net hospital [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-13-03.