ArticleAnnals of surgical oncology2025
Medicaid Expansion Is Associated with Lower Mortality in Patients with Locally Advanced Breast Cancer.
Article in Annals of surgical oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundStudies show that Medicaid expansion leads to timely diagnosis and treatment of early-stage breast cancer; however, no studies have examined its impact on locally advanced breast cancer (LABC). We assessed LABC rates pre- and post-Medicaid expansion, and evaluated overall survival (OS) in LABC patients treated in expansion and non-expansion states.
methodsOverall, 5147 National Cancer Database participants age 40-64 years diagnosed with LABC between 2010 and 2017 were allocated into the two cohorts. Demographic/clinical variables were compared using the Wilcoxon rank-sum and Pearson's Chi-square tests. A generalized linear model assessed trends in LABC diagnoses over time, while a Cox proportional hazards model evaluated associations between Medicaid expansion status and OS.
resultsA total of 3346 and 1801 LABC patients resided in expansion and non-expansion states, respectively. Ninety-one percent of non-expansion patients resided in the Southern United States (p < 0.001) versus 8.2% of expansion patients. Non-expansion patients were more likely to be non-Hispanic Black and/or have lower income (p < 0.001), while expansion patients were more likely to be Asian/Pacific Islander, Hispanic, metropolitan-area residents, and/or academic/research program-treated (p < 0.001). Trimodality therapy use was similarly low between non-expansion and expansion patients (68% and 70%, respectively; p = 0.054), while OS improved in expansion versus non-expansion patients post-policy implementation (p < 0.001). On multivariable analysis, triple-negative subtype (p < 0.001) and residence in a non-expansion state (p = 0.015) were associated with worse survival, while receipt of trimodality therapy (p < 0.001) was associated with improved survival.
conclusionsWhile trimodality therapy was associated with improved survival, less than three-quarters of patients received this treatment in both state types. Medicaid expansion was associated with improved OS in the post-implementation era, suggesting that these changes in Medicaid coverage may positively impact LABC outcomes.
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