New JNCCN study suggests Medicaid expansion improves cancer care and survival for people with aggressive type of breast cancer

PLYMOUTH MEETING, PA [October 24, 2024] — New research published online-ahead-of-print in JNCCN—Journal of the National Comprehensive Cancer Network found that people with newly-diagnosed hormone receptor (HR)-negative, human epidermal growth factor receptor 2 (HER2)-positive breast cancer were more likely to receive timely, guideline-concordant treatment and have longer survival in states that participate in Medicaid expansion under the Affordable Care Act (ACA).

A team of researchers—led by the American Cancer Society (ACS), and including Kathryn J. Ruddy, MD, MPH, of the Mayo Clinic Comprehensive Cancer Center, a former NCCN Foundation^® Young Investigator Award recipient—used data from the National Cancer Database (NCDB) to review results for women across the United States, age 18-62, who were diagnosed with this type of breast cancer between 2010 and 2018. 19,248 of the patients lived in Medicaid expansion states, while 12,153 resided in non-expansion locations. In the expansion states, the 2-year survival rate increased from the 2010 baseline rate of 93.9% to 95.0% across the study period. However, in the non-expansion states, 2-year survival declined slightly from 94.0% to 93.9%. The biggest difference was seen in patients with Stage III disease.

“Expanding Medicaid to the 10 states that have yet to do so can help ensure that more patients with cancer benefit from life-saving treatments,” said lead researcher Kewei Sylvia Shi, MPH, Surveillance and Health Equity Science, American Cancer Society. “It’s crucial to increase access to oncology services, expand insurance coverage, and streamline diagnostic and referral processes. Stage III cancer represents a critical point in disease presentation and can further progress and become incurable if undertreated. Having health insurance coverage will make it more likely for these patients to receive timely and comprehensive access to life-saving therapies, have better medication adherence, and complete treatment, which leads to better survival outcomes.”

HR-negative, HER2-positive breast cancer is an aggressive subtype that accounts for approximately 5% of all breast cancer diagnoses.¹ This is the first study to focus on the impact of Medicaid expansion on that specific population.

The study found that treatment according to recommendations from evidence-based, expert consensus driven clinical practice guidelines—such as the National Comprehensive Cancer Network^® (NCCN^®) Clinical Practice Guidelines in Oncology (NCCN Guidelines^®)— was more likely to begin within 90 days from diagnosis in the expansion states.

“This study reinforces the important role Medicaid expansion plays in ensuring that women newly diagnosed with HR-negative, HER2-positive breast cancer have equitable access to the healthcare services they need—especially when prognosis depends on access to treatment,” said Millicent Gorham, CEO of the Alliance for Women’s Health and Prevention, who was not involved in this research. “Breast cancer is far too common, and rates are increasing among younger women, making it critical that policymakers also prioritize women’s access to preventive health screenings and appropriate treatments.”

To read the entire study, visit JNCCN.org. Complimentary access to “Association of Medicaid Expansion With Timely Receipt of Treatment and Survival Among Patients With HR-Negative, HER2-Positive Breast Cancer” is now available online. The article will also be featured in the November 2024 print edition of the journal.

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About JNCCN—Journal of the National Comprehensive Cancer Network

More than 25,000 oncologists and other cancer care professionals across the United States read JNCCN—Journal of the National Comprehensive Cancer Network. This peer-reviewed, indexed medical journal provides the latest information about innovation in translational medicine, and scientific studies related to oncology health services research, including quality care and value, bioethics, comparative and cost effectiveness, public policy, and interventional research on supportive care and survivorship. JNCCN features updates on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®), review articles elaborating on guidelines recommendations, health services research, and case reports highlighting molecular insights in patient care. JNCCN is published by Harborside/BroadcastMed. Visit JNCCN.org. To inquire if you are eligible for a FREE subscription to JNCCN, visit NCCN.org/jnccn/subscribe. Follow JNCCN at x.com/JNCCN.

About the National Comprehensive Cancer Network

The National Comprehensive Cancer Network^® (NCCN^®) is a not-for-profit alliance of leading cancer centers devoted to patient care, research, and education. NCCN is dedicated to improving and facilitating quality, effective, equitable, and accessible cancer care so all patients can live better lives. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®) provide transparent, evidence-based, expert consensus recommendations for cancer treatment, prevention, and supportive services; they are the recognized standard for clinical direction and policy in cancer management and the most thorough and frequently-updated clinical practice guidelines available in any area of medicine. The NCCN Guidelines for Patients^® provide expert cancer treatment information to inform and empower patients and caregivers, through support from the NCCN Foundation^®. NCCN also advances continuing education, global initiatives, policy, and research collaboration and publication in oncology. Visit NCCN.org for more information.

[1] National Cancer Institute. Cancer stat facts: female breast cancer subtypes. Available at: https://seer.cancer.gov/statfacts/html/breast-subtypes.html