Dr. Avinash Bhakta, lead author of the study, is a colorectal cancer surgeon at the University of Kentucky Markey Cancer Center. | Courtesy of UK

Medicaid expansion has had positive effects on colorectal cancer screenings in Kentucky, especially in Appalachia, according to a recently published study by researchers at the University of Kentucky.

The study, which appeared in the Journal of the American College of Surgeons, was designed to evaluate the effect of Medicaid expansion on colorectal cancer screenings, incidence and survival in Kentucky, with an emphasis on eastern Kentucky.

Dr. Avinash Bhakta of the UK Markey Cancer Center was motivated to do the study after bonding with a patient from a nearby Appalachian town and witnessing the poverty there as political uncertainty continued to swirl in the commonwealth about whether Kentucky will end Medicaid expansion.

“I’m not a politician. I am a colorectal surgeon, and I really wanted to see, was there any data to support it” and “whether or not the Affordable Care Act (ACA) and Medicaid expansion had any impact on colorectal cancer at all,” he told Insider.

Screenshot from U.S. Centers for Disease Control and Prevention brochure

Kentucky’s Medicaid expansion began in January 2014 and was followed by a sharp drop in the state’s uninsured rate, from nearly 14 percent to 6 percent within the first two years, according to the Journal article.

Lack of insurance coverage is considered a barrier to getting screened for colorectal cancer, which includes cancers of the colon and rectum. More than 2,300 new cases are expected in Kentucky this year, along with an estimated 820 deaths, according to the American Cancer Society.

Colorectal cancer is one the few types of cancer that can be prevented through timely screening, which is generally recommended to begin at age 50 or 45 — depending on the organization setting the guidelines — if the person is at average risk.

Among the states, Kentucky is No. 1 in the incidence of colorectal cancer and falls within the top six in terms of the death rate, according to the cancer society.

“A lot of that comes from the Appalachian population,” Bhakta said.

For the UK study, a research team examined data from the Kentucky Hospital Discharge Database and the Kentucky Cancer Registry. The study population included more than 930,000 adults screened between January 2011 and December 2016.

“A total of 408,500 patients were screened pre-ACA, and 521,676 were screened after ACA implementation — an increase of 27.7 percent,” according to the study.

Even more striking, “a total of 69,328 Medicaid patients received screening after ACA implementation compared with 20,980 individuals who were screened pre-ACA, representing an increase of 230 percent,” the study noted. “Screening rates for patients with private insurance increased by 10.2 percent, and Medicare patients increased by 29.9 percent.”

“Our rate of screening increased in the Medicaid population by over 290 percent in the 51-to-65-year age group,” said Bhakta, the study’s lead author.

Overall, nearly 44 percent more Appalachian patients got screened after expansion than before it, the study noted.

Researchers found there was no significant increase in incidence (5,665 pre-ACA cancers vs. 5,776 after ACA). However, when separated by insurance, the proportion of Medicaid patients who were diagnosed with colorectal cancer increased by more than 132 percent after Medicaid expansion.

Also, among those with Medicaid, there was an increase in Appalachian colorectal cancer incidence of  nearly 88 percent.

“We demonstrated a trend toward higher rates of early stage (I and II) CRC diagnosis in the Appalachian population, which was not seen in the uninsured population,” the researchers wrote. “Because this study evaluated the short-term effects of Medicaid expansion, we would not expect a decrease in CRC incidence.”

Researchers also looked at survival and found that “patients with Medicaid in the post-expansion era had increased survival,” Bhakta said. So the increased screening “paid dividends … especially in the Medicaid population and even more so in the Appalachian Medicaid population.”

Shortly after the expansion, “Medicaid patients had a 27 percent lower risk of death compared with pre-ACA, while those who were uninsured had an overall worse survival,” the study stated. “Notably, the Kentucky Appalachian patients also had a significantly improved survival associated with the dramatic expansion of Medicaid coverage as a result of increased CRC screening.”

Bhakta said there will be further research to uncover longterm trends.

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Darla Carter
Darla Carter is a hometown girl who recently joined the staff of Insider Louisville to mostly cover health. She previously served as a longtime health and fitness writer for The Courier-Journal, where she also worked for the Metro, Neighborhoods and Features departments. Prior to that, the award-winning journalist wrote for newspapers elsewhere in Kentucky and Tennessee, covering a range of topics, from education to courts. She's a graduate of Western Kentucky University, where she studied journalism and philosophy, and is the proud mom of two young children.