Abstract A125: The impact of the 2010 Patient Protection and Affordable Care Act (ACA) on colorectal cancer screening in vulnerable populations: A systematic literature review

Abstract

Abstract Background: Disparities have existed and continue to exist in colorectal cancer (CRC) screening. Disparities in screening are correlated with other factors including educational attainment, healthcare access/insurance, and family history knowledge. These factors impact different vulnerable communities differently. This paper explores the impact of the 2010 Patient Protection and Affordable Care Act (ACA) on CRC screening rates and disparities in the United States. Methods: A comprehensive systematic literature review conducted in June 2019 revealed 47 published articles that explore the impact of the ACA on CRC screening. Results: The ACA affected CRC screening primarily in three ways: 1) costs associated with screening and diagnostic follow-up were reduced among commercially-insured patients, removing financial barriers; 2) uninsured, non-Medicaid-eligible individuals were able to gain access to healthcare services such as CRC screening through insurance plans purchased through health exchanges; and 3) vulnerable and high-risk populations gained access through the expansion of and changes to Medicaid in 32 states. These three pathways reduced screening disparities between various ethnic and racial populations, yet disparities remain. Conclusions: The ACA expanded access to screening and treatment efforts in order to decrease cancer incidence, increase early detection, decrease costly CRC management, and extend life expectancy for CRC survivors. Yet, the limited literature shows mixed results in terms of the ACA’s impact, especially in its initial phase. While screening technologies and systemic changes by the ACA have made significant progress in reaching high-risk and vulnerable populations including ethnic and racial minorities, there is still a concerning gap in both access to CRC screening services and the associated disparities in mortality. Future research should focus on delayed impacts of the ACA. Citation Format: Joshua S Yudkin, V. Paul Doria-Rose. The impact of the 2010 Patient Protection and Affordable Care Act (ACA) on colorectal cancer screening in vulnerable populations: A systematic literature review [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A125.