Potential impact of the Affordable Care Act's preventive services provision on breast cancer stage: A preliminary assessment

•As of January 1, 2011, the Affordable Care Act (ACA) eliminated copayments for mammography and other recommended preventive services.•A national cancer registry was used to examine the impact of the ACA's preventative services provision on breast cancer stage and racial/ethnic disparities in stage.•All three racial/ethnic groups experienced a shift toward stage I breast cancer and a small reduction in stage disparities was observed.•Preliminary data suggest that the ACA's elimination of copayments for preventive services such as cancer screening may have a meaningful impact on cancer outcomes and disparities.

IntroductionThe Affordable Care Act's (ACA) preventive services provision (PSP) removes copayments for preventive services such as cancer screening. We examined: 1) whether a shift in breast cancer stage occurred, and 2) the impact of the provision on racial/ethnic disparities in stage.Materials and methodsData from the National Cancer Database were used. The pre- and post-PSP periods were identified as 2007-2009 and 2011-2013, respectively. Proportion differences (PDs) and 95% confidence Intervals (CIs) were calculated.ResultsAll three racial/ethnic groups experienced a statistically significant shift toward Stage I breast cancer. Pre-PSP, the black:white disparity in Stage I cancer was −9.5 (95% CI: −8.9, −10.4) and the Latina:white disparity was −5.2 (95% CI: −4.0, −6.1). Post-PSP, the disparities improved slightly.DiscussionPreliminary data suggest that the ACA's PSP may have a meaningful impact on cancer stage overall and by race/ethnicity. However, more time may be needed to see reductions in disparities.