Category Ranking
98%
Total Visits
921
Avg Visit Duration
2 minutes
Citations
20
Article Abstract
Background: Kentucky ranks first in the US in cancer incidence and mortality. Compounded by high poverty levels and a high rate of medically uninsured, cancer rates are even worse in Appalachian Kentucky. Being one of the first states to adopt the Affordable Care Act (ACA) Medicaid expansion, insurance coverage markedly increased for Kentucky residents. The purpose of our study was to determine the impact of Medicaid expansion on colorectal cancer (CRC) screening, diagnosis, and survival in Kentucky.
Study Design: The Kentucky Cabinet for Health and Family Services and the Kentucky Cancer Registry were queried for individuals (≥20 years old) undergoing CRC screening (per US Preventative Services Task Force) or diagnosed with primary invasive CRC from January 1, 2011 to December 31, 2016. Colorectal cancer screening rates, incidence, and survival were compared before (2011 to 2013) and after (2014 to 2016) ACA implementation.
Results: Colorectal cancer screening was performed in 930,176 individuals, and 11,441 new CRCs were diagnosed from 2011 to 2016. Screening for CRC increased substantially for Medicaid patients after ACA implementation (+230%, p < 0.001), with a higher increase in screening among the Appalachian (+44%) compared with the non-Appalachian (+22%, p < 0.01) population. The incidence of CRC increased after ACA implementation in individuals with Medicaid coverage (+6.7%, p < 0.001). Additionally, the proportion of early stage CRC (stage I/II) increased by 9.3% for Appalachians (p = 0.09), while there was little change for non-Appalachians (-1.5%, p = 0.60). Colorectal cancer survival was improved after ACA implementation (hazard ratio 0.73, p < 0.01), particularly in the Appalachian population with Medicaid coverage.
Conclusions: Implementation of Medicaid expansion led to a significant increase in CRC screening, CRC diagnoses, and overall survival in CRC patients with Medicaid, with an even more profound impact in the Appalachian population.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6537585 | PMC |
| http://dx.doi.org/10.1016/j.jamcollsurg.2018.12.035 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
The role and mechanism of abnormal lipid metabolism in colorectal cancer.
Sci Prog
September 2025
Shenzhen University Sixth Affiliated Hospital, Shenzhen Nanshan People's Hospital, Shenzhen, China.
Colorectal cancer ranks among the most prevalent and lethal malignant tumors globally. Historically, the incidence of colorectal cancer in China has been lower than that in developed European and American countries; however, recent trends indicate a rising incidence due to changes in dietary patterns and lifestyle. Lipids serve critical roles in human physiology, such as energy provision, cell membrane formation, signaling molecule function, and hormone synthesis.
View Article and Find Full Text PDFEphA3/EFNA3 Reverse Signalling Promotes Epithelial-to-Mesenchymal Transition via ERK Pathway to Facilitate Colorectal Cancer Metastasis.
Dig Dis Sci
September 2025
Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
Background And Aims: Liver metastasis significantly contributes to poor survival in patients with colorectal cancer (CRC), posing therapeutic challenges due to limited understanding of its mechanisms. We aimed to identify a potential target critical for CRC liver metastasis.
Methods: We analyzed the Gene Expression Omnibus (GEO) and the Cancer Genome Atlas (TCGA) databases and identified EphrinA3 (EFNA3) as a potential clinically relevant target.
Exploring tumour-microbe interactions: in vitro and in vivo modelling of Streptococcus bovis-induced colorectal carcinogenesis.
Mol Biol Rep
September 2025
Department of Medical Microbiology and Parasitology, Faculty of Medicine, Selangor Branch, Universiti Teknologi MARA (UiTM) Sungai Buloh Campus, Jalan Hospital, Sungai Buloh, 47000, Selangor, Malaysia.
Streptococcus bovis is an opportunistic bacterium consistently associated with colorectal cancer (CRC). This article reviews previous experimental evidence that has successfully demonstrated the role of S. bovis species in the context of CRC.
View Article and Find Full Text PDFMechanistic insights and nanomedicine innovations of oligomeric proanthocyanidin in precision oncology: Ablating self-renewal capacity of metastatic cancer stem cells via multi-pathway modulation.
Med Oncol
September 2025
Department of Biotechnology, Institute of Engineering and Management, University of Engineering and Management, Kolkata, Kolkata, India.
Oligomeric proanthocyanidins (OPCs), condensed tannins found plentiful in grape seeds and berries, have higher bioavailability and therapeutic benefits due to their low degree of polymerization. Recent evidence places OPCs as effective modulators of cancer stem cell (CSC) plasticity and tumor growth. Mechanistically, OPCs orchestrate multi-pathway inhibition by destabilizing Wnt/β-catenin, Notch, PI3K/Akt/mTOR, JAK/STAT3, and Hedgehog pathways, triggering β-catenin degradation, silencing stemness regulators (OCT4, NANOG, SOX2), and stimulating tumor-suppressive microRNAs (miR-200, miR-34a).
View Article and Find Full Text PDFCT-Based Radiomics Models with External Validation for Prediction of Recurrence and Disease-Specific Mortality After Radical Surgery of Colorectal Liver Metastases.
Ann Surg Oncol
September 2025
HepatoBiliaryPancreatic Surgery, AOU Careggi, Department of Experimental and Clinical Medicine (DMSC), University of Florence, Florence, Italy.
Purpose: To build computed tomography (CT)-based radiomics models, with independent external validation, to predict recurrence and disease-specific mortality in patients with colorectal liver metastases (CRLM) who underwent liver resection.
Methods: 113 patients were included in this retrospective study: the internal training cohort comprised 66 patients, while the external validation cohort comprised 47. All patients underwent a CT study before surgery.