title: Elimination of cost-sharing and receipt of screening for colorectal and breast cancer.
abstract: BACKGROUND
  The aim of the cost-sharing provision of the Patient Protection and Affordable Care Act (ACA) was to reduce financial barriers for preventive services, including screening for colorectal cancer (CRC) and breast cancer (BC) among privately and Medicare-insured individuals. Whether the provision has affected CRC and BC screening prevalence is unknown. The current study investigated whether CRC and BC screening prevalence among privately and Medicare-insured adults by socioeconomic status (SES) changed before and after the ACA.
  
  
  METHODS
  Data obtained from the National Health Interview Survey pertaining to privately and Medicare-insured adults from 2008 (before the ACA) and 2013 (after the ACA) were used. There were 15,786 adults aged 50 to 75 years in the CRC screening analysis and 14,530 women aged ≥40 years in the BC screening analysis. Changes in guideline-recommended screening between 2008 and 2013 by SES were expressed as the prevalence difference (PD) and 95% confidence interval (95% CI) adjusted for demographics, insurance, income, education, body mass index, and having a usual provider.
  
  
  RESULTS
  Overall, CRC screening prevalence increased from 57.3% to 61.2% between 2008 and 2013 (P<.001). Adjusted CRC screening prevalence during the corresponding period increased in low-income (PD, 5.9; 95% CI, 1.8 to 10.2), least-educated (PD, 7.2; 95% CI, 0.9 to 13.5), and Medicare-insured (PD, 6.2; 95% CI, 1.7 to 10.7) individuals, but not in high-income, most-educated, and privately insured respondents. BC screening remained unchanged overall (70.5% in 2008 vs 70.2% in 2013) and in the low SES groups.
  
  
  CONCLUSIONS
  Increases in CRC screening prevalence between 2008 and 2013 were confined to respondents with low SES. These findings may in part reflect the ACA's removal of financial barriers.
authors.affiliation: Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia.|Department of Epidemiology, Emory University, Atlanta, Georgia.
authors.forename: Stacey A
authors.initials: SA
authors.lastname: Fedewa
authors.affiliation: Department of Epidemiology, Emory University, Atlanta, Georgia.
authors.forename: Michael
authors.initials: M
authors.lastname: Goodman
authors.affiliation: Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia.|Department of Epidemiology, Emory University, Atlanta, Georgia.
authors.forename: W Dana
authors.initials: WD
authors.lastname: Flanders
authors.affiliation: Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia.
authors.forename: Xuesong
authors.initials: X
authors.lastname: Han
authors.affiliation: Cancer Control Science, American Cancer Society, Atlanta, Georgia.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Smith
authors.affiliation: Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: M Ward
authors.affiliation: Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Chyke A
authors.initials: CA
authors.lastname: Doubeni
authors.affiliation: Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia.
authors.forename: Ann Goding
authors.initials: AG
authors.lastname: Sauer
authors.affiliation: Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia.|Department of Epidemiology, Emory University, Atlanta, Georgia.
authors.forename: Ahmedin
authors.initials: A
authors.lastname: Jemal
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000191:economics; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000191:economics; D017047:Cost Sharing / Q000191:economics / Q000379:methods; D055088:Early Detection of Cancer / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000706:statistics & numerical data*; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act; D012959:Socioeconomic Factors; D014481:United States
keywords: breast neoplasms; colorectal neoplasms; early detection of cancer; insurance