研究人员认为Obamacare有助于发现早期癌症

资料来源：http://www.reuters.com/article/us-health-coloncancer-obamacare-idUSKBN157292

The Affordable Care Act likely extended the lives of thousands of seniors who took advantage of free screening exams and were diagnosed with treatable, early-stage colorectal cancer, a new study suggests.

“I think the prevention-related provisions of the Affordable Care Act helped to detect cancer at earlier and more treatable stages and eventually will save lives,” said senior author Nengliang “Aaron” Yao, a health-policy professor at the University of Virginia School of Medicine in Charlottesville.

Before the Affordable Care Act, often called Obamacare, took effect, people ages 65 and older who were insured under Medicare had to pay $275 for colonoscopies, the report in Health Affairs says.

The Affordable Care Act (ACA) directed that colonoscopies be offered for free.

From 2011, when the law took effect, until 2013, an additional 8,400 seniors, or 8 percent more than before, were diagnosed with early-stage colorectal cancer, researchers estimated.

“The study does a very nice job of showing that when you remove financial barriers to healthcare, health improves,” said Dr. Cary Gross, a professor at the Yale School of Medicine, in New Haven, Connecticut who was not involved in the study. “When the Affordable Care Act granted more generous coverage, we were more likely to detect cancer at an earlier stage.”

“This shows that when it comes to creating a new healthcare plan, the devil’s in the details, and policymakers need to look at things like how will the proposed changes affect cancer screening,” Gross said in a phone interview.

Colorectal cancer is the second leading cause of U.S. cancer-related deaths, according to the U.S. Centers for Disease Control and Prevention, or CDC. Nearly 52,000 Americans died from colorectal cancer in 2013.

Though research shows that screening reduces the risk of dying from colorectal cancer, only 25 percent of uninsured people and 60 percent of insured people had been screened as recommended, a 2015 CDC study showed.

Both Yao and Gross would like President Donald Trump and Republican lawmakers, who have pledged to repeal the ACA, to consider the ramifications of the new study before ruling on future healthcare legislation.

“I’m very concerned that policymakers who are trying to save money by not covering cancer-prevention services are being penny-wise and pound-foolish,” Gross said. “They may save money today, but we will be paying a lot more taking care of patients with metastatic cancer down the road.”

“I’m worried on behalf of our patients and our communities that these great strides we’ve made against cancer will evaporate if the important provisions of the Affordable Care Act, which ensure that patients can access cancer screening services without additional costs, are taken away,” he said.

In the new study, researchers examined data from 18 cancer registries across the U.S. They found no change in the number of Medicare early-stage cancer diagnoses for breast cancer between the period before Obamacare, from 2008 until 2010, until the period after, from 2011 until 2013.

Mammography to screen for breast cancer became free for Medicare patients under the ACA, but before that, it cost just $9 – a significantly smaller financial barrier than the $275 cost of a colonoscopy, Yao said in a phone interview.

In addition, breast cancer screening had been marketed more successfully than colorectal screening before the ACA was enacted, he said.

Gross noted that colonoscopies can actually prevent cancer, because doctors can remove polyps during the procedure, whereas mammograms only allow doctors to see growths in the breast.

The U.S. Preventive Services Task Force found convincing evidence that colorectal cancer screening substantially reduces deaths in adults between 50 and 75 years old, it said last year. The task force recommended screening with colonoscopy, stool analyses or flexible sigmoidoscopy combined with a fecal-occult blood test.

The new study could not determine the impact of free colonoscopies on metastatic colorectal cancer rates or mortality from colorectal cancer. Gross urged follow-up studies examining those numbers after they become available.