Dr. Lindsay Sabik, Ph.D. Associate Professor Graduate School of Public Health Department of Health Policy and Management University of Pittsburgh

Decreased Advanced Colon Cancer Diagnosis After Massachusetts Insurance Reform

MedicalResearch.com Interview with:

Dr. Lindsay Sabik, Ph.D. Associate Professor Graduate School of Public Health Department of Health Policy and Management University of Pittsburgh

Dr. Sabik

Dr. Lindsay Sabik, Ph.D.
Associate Professor
Graduate School of Public Health
Department of Health Policy and Management
University of Pittsburgh 

MedicalResearch.com: What is the background for this study?

Response: In 2006, Massachusetts passed a health insurance reform law with the aim of providing health care access to nearly all of its residents. My colleagues and I pulled data from the Massachusetts Cancer Registry on all colorectal and breast cancer cases in people ages 50- to 64-years-old from 2001 through 2013.

We selected those two cancers for our study because both are common, have routine screening guidelines and have high survival rates when caught early. The age range captured people covered by the recommended screening guidelines but not old enough to qualify for Medicare. We also pulled similar data from several other states for comparison.

MedicalResearch.com: What are the main findings?

Response: For colorectal cancer, we found a 7% decline in the likelihood of advanced stage diagnosis after Massachusetts health insurance reform was enacted relative to trends in comparison states. We did not find a comparable decline in advanced stage breast cancer diagnosis, likely because there already were well-established state and federal safety net programs that highly encouraged breast cancer screenings and provided them at low or no cost, regardless of insurance status, before Massachusetts enacted its health insurance reform. So, we believe that those programs were already catching people who otherwise might not have been screened due to insurance status, which is good news — it demonstrates that those safety net programs appear to work.

MedicalResearch.com: What should readers take away from your report?

Response: Our study demonstrates the public health value of expanded health insurance coverage. Colorectal cancers are the second-leading cause of cancer deaths nationwide. The U.S. Preventive Service Task Force recommends everyone over age 50 receive routine screening for colorectal cancer, which has a 90% survival rate when treated early. That rate drops substantially when the cancer is diagnosed in advanced stages. Colorectal cancer frequently occurs in adults under 65 who are not yet eligible for Medicare. And we know from previous research that people who do not have health insurance or who are underinsured are less likely to get recommended preventive health screenings. Cancer is only one disease area where preventive care and early diagnosis can make a big difference in survival and cost of treatmen 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Our study is the first to present evidence that Massachusetts’ health reform may be associated with a shift to earlier stage diagnosis for a cancer that has a high cure rate when caught early. This is exciting because key elements of the Affordable Care Act, signed into law in 2010, parallel those of the Massachusetts reform. While data on the long-term impacts are still emerging, we expect that early cancer diagnosis will likely be one of the major success stories of national health insurance reform. For example, when we extrapolate our findings in Massachusetts to the entire U.S., we estimate that there would be 2,100 fewer late-stage colorectal cancer diagnoses annually among non-elderly people. According to the National Cancer Institute, colorectal cancer care in the U.S. costs an estimated $16.3 billion annually. 

MedicalResearch.com: Is there anything else you would like to add? 

Response: Additional authors on this study are Kristen Y. Eom, M.P.H., and Jie Li, Ph.D., both of Pitt; Bassam Dahman, Ph.D., of Virginia Commonwealth University; Nengliang Yao, Ph.D., of the University of Virginia; G.J. van Londen, M.D., M.S., of UPMC Magee-Womens Hospital; and Cathy J. Bradley, Ph.D., of the University of Colorado Comprehensive Cancer Center.

This research was funded by American Cancer Society grant RSG-16-017-01-CPHPS, National Cancer Institute grant P30 CA047904 and the Magee-Womens Research Institute and Foundation.


Med Care. 2020 Feb;58(2):183-191. doi: 10.1097/MLR.0000000000001241.

The Impact of Massachusetts Health Reform on Colorectal and Breast Cancer Stage at Diagnosis.
Sabik LM1, Eom KY1, Dahman B2, Li J1, Yao N3, van Londen GJ4, Bradley CJ5.



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Last Updated on January 23, 2020 by Marie Benz MD FAAD