When a state expands Medicaid, do women with breast cancer live longer? A team led by researchers at Howard University College of Medicine has delivered new evidence, and its findings are gaining national attention.

Published Jan. 27 in JAMA Network Open, the new study found that Medicaid expansion under the Affordable Care Act was associated with a significant reduction in overall mortality among women with breast cancer. The findings highlight how Howard University, an R1 research institution, is using research to address important public health issues, including access to care and disparities in cancer outcomes.

Together, the two studies provide a timely opportunity to talk with Howard medical researchers about how insurance coverage and access to care intersect with cancer survival, as well as why the benefits are not uniform across racial, ethnic and socioeconomic groups.

The breast cancer research has already received coverage from outlets including Stateline, Targeted Oncology.  The study was also recently featured by the National Breast Cancer Coalition’s Science Spotlight and in its Webinar Spotlight on Medicaid Expansion and Breast Cancer Survival.

That commitment to breast cancer care also extends into the community. On Saturday, Oct. 3, the Georgiana Thomas Grand Chapter, Order of the Eastern Star, PHA, will host its 23rd Annual Margaret E. Anderson Breast Cancer Walk, with proceeds benefiting the High-Risk Breast Cancer Program at Howard University Cancer Center. To register for the walk or learn more, visit the Howard University event page.

The new Medicaid research study analyzed medical data from nearly 1.6 million women ages 40 to 64 who were diagnosed with breast cancer between 2006 and 2021, using the National Cancer Database. The research team found that Medicaid expansion was associated with a 1.4 percentage-point reduction in five-year mortality, equivalent to about 1,400 fewer deaths per 100,000 women over five years.

In states that did not expand Medicaid, researchers found no significant change in mortality. The study’s first author, Oluwasegun Akinyemi, M.D., Ph.D., is a health services researcher and research scientist at the Clive O. Callender Outcomes Research Center at the Howard University College of Medicine.

The breast cancer findings are part of a broader body of research by Howard University researchers examining the relationship between health coverage and cancer outcomes. In a study published this month in JAMA Network Open, Akinyemi and colleagues extended that research to colorectal cancer, analyzing more than 658,000 adults and finding that Medicaid expansion was associated with a 6.3% relative reduction in the hazard of death, as well as increases in early-stage diagnosis and surgical treatment.

“We have been able to show that Medicaid expansion was associated with a significant reduction in overall mortality among women who had breast cancer,” Akinyemi said. “Medicaid expansion saves lives. These policies works.”

The study's Howard co-authors include Kakra Hughes, M.D., Ph.D., in the Department of Surgery; Miriam Michael, M.D., associate professor and internal medicine clerkship director; Robin Williams, M.D., associate professor and director of Breast Surgical Oncology at Howard University Hospital; and Shari Lawson, M.D., associate professor and the John F. J. Clark Endowed Chair of Obstetrics and Gynecology.

The findings have drawn widespread public interest. The study has been featured in Stateline, Targeted Oncology and Healio. The National Breast Cancer Coalition also featured the research in its Science Spotlight series and invited Akinyemi and the Howard researchers to participate in its national webinar, “Access to Care Matters: Medicaid Expansion and Breast Cancer Survival,” on Sept. 10.

The Stakes Are High

The research study compared changes in breast cancer outcomes over time in states that expanded Medicaid with changes in states that did not. This allowed the researchers to determine whether mortality rates changed after Medicaid expansion was implemented. The team also conducted additional analyses to test the strength of its findings.

Michael, an associate professor and clerkship director at the departmentDepartment of internal medicineInternal Medicine, said the stakes reach far beyond hospitals and cancer clinics.

“Fourteen hundred lives per 100,000 is an incredible number, especially when you see whose lives are being saved,” Michael said. “These are women aged 40 to 64 — taxpayers, caretakers of children and of aging parents. When we take away benefits that keep working people healthy, it actually costs states more, not less.”

The study was supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health and conducted through the Clive O. Callender Outcomes Research Center at Howard University College of Medicine.

Who Does and Does Not Benefit from Expanded Coverage?

The study also found a troubling disparity by neighborhood income. The finding suggests that insurance coverage alone does not eliminate the barriers that can prevent patients from accessing and completing care.

Speaking during the webinar, Michael said those barriers include limited transportation, the inability to take time off work, a lack of child carechildcare, unstable housing and fragmented care, in which services are spread across multiple providers and settings.

“These barriers fall hardest on women of lower socioeconomic status, and they are separate from the disease and separate from insurance,” said Michael, whose research uses population-level data to examine clinical outcomes and health disparities.

Williams said the findings reflect what she sees in her practice.

“The most important finding is that access matters,” Williams said. “As a practicing breast surgeon, I see it play out every day: patients who miss appointments because they have no transportation, or who are limited in when they can come because they have no childcare.”

The findings also point to differences in how the benefits of expanded coverage are experienced across populations. In the breast cancer study, Hispanic women experienced a 19% reduction in the hazard of death, compared with a 4.3% reduction among non-Hispanic Black women and a 3.4% reduction among non-Hispanic Wwhite women. 

The gains were particularly pronounced among women in later stages of the disease. Women diagnosed with stage 4 breast cancer experienced a 13.9% reduction in the hazard of death, while women receiving immunotherapy experienced a 24.1% reduction.