Dr. Polk, who served one year as Kentucky’s public health commissioner under current Kentucky Gov. Matt Bevin, said of the sharp increase in mammography rates in Kentucky, “It bent the curve upward.”

Breast cancer incidence and treatment rates did not vary significantly from year to year. However, the changes in the rates of early-stage vs. late-stage disease treated in the pre- and post-Medicaid expansion periods were statistically significant. Early stage (stage I-II) breast cancers accounted for 64.5 percent of the diagnoses in 2011-2013 vs. 66.7 percent in 2014-2016; late-stage (III-IV) cancers comprised 15 percent vs. 12.9 percent in the respective periods (p=0.002).


Rates for breast-conserving surgery increased significantly after Medicaid expansion—from 44 percent pre-expansion to 48.8 percent (p<0.001)—whereas rates of other resections, including mastectomy, declined—from 50.5 percent to 44.5 percent.

While time from diagnosis to surgical treatment for the disease was shorter before expansion—an average of 28.6 days vs. 36 (p<0.001)—two other key treatment variables were either unchanged or improved after expansion: time from the operation to chemotherapy (47.5 days before expansion and 46.6 days after, p=0.26); and time from the operation to radiation (96.4 days vs. 91.5, p<0.001).

The study noted that the findings mirrored those of other state experiences with either expansion or contraction of Medicaid programs, but Dr. Polk said that a thorough analysis of the Medicaid expansion in Kentucky requires a longer-term study. “This needs to be re-done in three more years so we have five years of follow-up,” he explained.

Study coauthors are Nicolas Ajkay, MD, FACS; Neal Bhutiani, MD; Jeffrey D. Howard, MD; Charles R. Scoggins, MD, MBA, FACS; and Kelly M. McMasters, MD, PhD, FACS, of The Hiram C. Polk, Jr. Department of Surgery, Division of Surgical Oncology, University of Louisville; Bin Huang, MS, of the department of biostatistics, College of Public Health, University of Kentucky, Lexington; Quan Chen, of the Biostatstics and Bioinformatics Shared Resource Facility, Markey Cancer Center, University of Kentucky; and Thomas C. Tucker, MPH, of the Kentucky Cancer Registry, Markey Cancer Center, University of Kentucky.

Citation: Evaluating the Early Impact of Medicaid Expansion on the Quality of Breast Cancer Care in Kentucky. Journal of the American College of Surgeons. Available at: http://www.journalacs.org/article/S1072-7515(18)30022-X/fulltext.

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About the American College of Surgeons
The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 80,000 members and is the largest organization of surgeons in the world.

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