From the U.S. Government Accountability Office, www.gao.gov Transcript for: The Declining Number of Breast and Cervical Cancer Screenings in CDC's Early Detection Program Description: Early screening and detection for cancer can improve patients' outcomes and, ultimately, save lives. The CDC's Early Detection Program provides screenings to those enrolled in Medicaid. However, the number of people screened under this program has declined significantly in recent years. We talk to John Dicken, an expert on health care policy, and a director in our Health Care Team, about a new report that looks at the reasons for this decline. Related GAO Work: GAO-21-35, Public Health: Federal Programs Provide Screening and Treatment for Breast and Cervical Cancer Released: November 2020 [Intro Music] [John Dicken:] For low-income individuals who many not have other insurance coverage there are programs available through CDC. [Holly Hobbs:] Hi and welcome to GAO's Watchdog Report, your source for news and information from the U.S. Government Accountability Office--I'm Holly Hobbs. About 265,000 women in the U.S. were diagnosed with breast or cervical cancer in 2017--according to the most recently available data from the CDC. Early screening and detection for cancer can improve patient outcomes and, ultimately, save lives. Yet, research has shown that low-income, uninsured and underinsured people face challenges in accessing timely screening and treatment for breast and cervical cancer. The CDC's Early Detection Program provides screenings for low-income individuals without insurance coverage. However, the number of people screened under this program has declined significantly in recent years. Today, we talk to John Dicken, an expert on health care policy, and a director in our Health Care Team, about a new report that looks at the reasons for this decline. Thank you for joining us John! [John Dicken:] Great, thank you. [Holly Hobbs:] So John, set the stage for us. How has the number of people who receive breast and cervical cancer screenings through CDC's program changed over the last--say--decade or so? [John Dicken:] There has been a notable decline in the number of people screened. When we looked back at--say 2011--there were more than 550,000 people who received screenings through the Early Detection Program, both for breast and cervical cancer. And then more recently, by 2018, that was just below 300,000 people who have received those screenings. And so, a notable decline during this period. [Holly Hobbs:] And what's causing this decline? Are fewer people qualifying for the Early Detection Program? [John Dicken:] Yeah, indeed these are for individuals --as you noted --that are low income and uninsured. And so, certainly during the decade there were changes. And the biggest change occurred around 2014 when key provisions of the Affordable Care Act were implemented that allowed a number of states that expanded their Medicaid programs and there were also availability of subsidized health insurance through exchanges. And so, we see the biggest decline both in the number of people screened by the CDC program, but also in the number of people eligible in that 2013, 2014 timeframe. So, a key factor was that there were people who were able to get that coverage through Medicaid or other programs. [Holly Hobbs:] And was the change in Medicaid enrollment among those who had qualified because of screenings through the Early Detection Program similar across states or ethnic groups? [John Dicken:] We do see that the decline affected different states different populations. That over time the decline was smaller among--for example--Hispanic individuals. Also, that the decline was greatest among states that did increase their Medicaid population. Among the group of states that did opt to expand Medicaid to individuals up to 133% of the poverty level, that there'd been a decline from 2016 to 2019 of about one-fourth of those people that were enrolled in Medicaid after receiving screenings. Whereas among other states that had not expand their Medicaid program there is actually a small increase in total enrollment. So that indicates that in both those states people may be becoming eligible for Medicaid, but that the pathway through the CDC program is more important for those states that did not otherwise expand their Medicaid program through the Affordable Care Act. [Music:] [Holly Hobbs:] It sounds like the screenings for breast and cervical cancer are important features for early detection and treatment, and can also save lives. And that while the number of screenings conducted through CDC's Early Detection Program has declined, patients might be receiving screenings outside of this program as a result of the Affordable Care Act. John, is there a concern that despite these changes in coverage that there could be a population of folks who don't have access to screenings under either Medicaid or the Affordable Care Act? Is this why the CDC's program is still needed? [John Dickens:] I think there were a mix of concerns both about whether or not the program was still meeting the need and that it was being effectively used. While the number of people that have received screens have decreased, as well as, the number of people eligible given the kind of expansion and people getting coverage--there's still millions of individuals who could be eligible that are not receiving the screenings. And there's still concerns that making sure that low-income individuals that would benefit from screenings are receiving that. [Holly Hobbs:] And John, last question, what's the bottom line of this report? [John Dicken:] The bottom line is that for low-income individuals who may not have other insurance coverage there are programs available through CDC that can provide screenings for both breast cancer, for cervical cancer. These programs are intended to help people get that screening. And then even beyond that when the screening does identify that people may need treatment Medicaid programs have ability to enroll people that may not otherwise be eligible. So this remains a key issue for a number of low-income individuals that can get early screening and treatment for breast and cervical cancer. [Holly Hobbs:] That was John Dicken talking about GAO's recent review of breast and cervical cancer screenings through CDC's Early Detection Program. Thank you for your time, John! [John Dicken:] Great, thank you. [Holly Hobbs:] And thank you for listening to the Watchdog Report. 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