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UPJ INSIGHT Long-Term Impact of Medicaid Expansion on Prostate Cancer Screening
By: Mayra I. Lucas, MPH, David Geffen School of Medicine at UCLA, Los Angeles, California, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Zhiyu Qian, MD, Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; Stuart R. Lipsitz, ScD, Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; Xi Chen, MPH, Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; Khalid Alkhatib, MB, BCh, Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; Adam S. Kibel, MD, Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; Alexander P. Cole, MD, Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; Hari S. Iyer, ScD, MPH, Section of Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick; Quoc-Dien Trinh, MD, MBA, Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts | Posted on: 19 Jan 2024
Lucas MI, Qian Z, Lipsitz SR, et al. Long-term impact of Medicaid expansion on prostate cancer screening. Urol Pract. 2024;11(1):77-85.
Study Need and Importance
PSA testing has been a controversial topic for decades but remains a widely used tool to screen for prostate cancer. Therefore, it is important to understand the long-term trends for PSA screening in populations with historically lower access to preventive care in light of the 2010 Medicaid expansion.
What We Found
PSA screening prevalence decreased from 2012 to 2020 in all states regardless of expansion status (Figure). The 2012 United States Preventive Services Task Force PSA screening guidelines is likely associated with the observed findings. However, no long-term effect of Medicaid expansion on PSA screening prevalence was observed among states with different Medicaid expansion status.
Limitations
The Behavioral Risk Factor Surveillance System survey excludes individuals who are institutionalized or without telephone access. The data in the survey are also self-reported and therefore subject to recall bias. Accordingly, the PSA test may have been performed at a period outside the policy intervention. We only report on PSA screening rates and not on how Medicaid access or lack thereof affects the health and health outcomes of participants.
Interpretation for Patient Care
PSA screening rates were not significantly influenced by Medicaid expansion in our target population. The trend may suggest a shift toward more selective screening practices. However, access to care is only 1 barrier to prostate cancer screening in populations with historically less access to care. It is important to consider other barriers that may hinder the ability of at-risk populations to utilize this tool routinely.
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