Health care reform and the effect on cancer prevention services

MD Anderson Cancer Center
Date: 05-21-12


[ Music ]

Lisa Garvin: Welcome to Cancer Newsline, a podcast series from the University Of Texas M.D. Anderson Cancer Center. Cancer Newsline helps you stay current with the news on cancer research, diagnosis, treatment, and prevention; providing the latest information on reducing your family's cancer risk. I'm your host Lisa Garvin. Today our guest is Dr. Lewis Foxhall. He is the vice president of health policy here at M.D. Anderson, and also a professor of clinical cancer prevention. Dr. Foxhall, we're here to talk about the repercussions from the passage of the Affordable Care Act in 2010. I do know that some 54 million people have availed themselves of now free preventive services as a result of this act. How has this played out?

Dr. Foxhall: The Affordable Care Act is a very interesting piece of legislation. This was, when it was passed, incorporated a vast array of different aspects and a couple of them in particular, I think, are impacting our ability to deliver preventive services. There are a number of preventive opportunities that are touched on in the act, and I think we can go over a few of those just to give a little more background. The 2 big areas that are important to consider are first the increased insurance coverage. Financial barriers are a big part of why a lot of people do not access preventive services. So as the act rolls out this will give people a opportunity to partake of preventive services where they didn't before. The other areas relate to specific provisions within the act that increase coverage, or reduced out of pocket costs for preventive services.

Lisa Garvin: And from what I understand the preventive services were supposed to be provided without cost sharing. So the cost of these were not to be passed on to the patient, is that correct?

Dr. Foxhall: That's correct. There are some aspects of the act that have already been rolled out. This has been a staged roll out over a period of time. Some of it has already started; some of it is yet to come. On the actual preventive services that are covered without out of pocket costs, a couple of things have happened already. First is within commercial plans, there's new plans which have been established or changed significantly since the development of the act, are now required to provide basic preventive services that are approved at a certain level by the United States Preventive Services task force, without any copays or out of pocket costs by beneficiaries of those plans. Also the Medicare program has now implemented some changes which will allow preventive services to be covered in the same fashion. So those are 2 big areas that will gradually increase the opportunities for people to partake of these services over time.

Lisa Garvin: As far as cancer preventive services I guess it's the big 3 that are included in this, and that would be mammography's and pap smears for women, and then colonoscopies for both men and women. Is that correct?

Dr. Foxhall: The screening services are included. The coverage does take care of the screenings for breast cancer, and actually includes coverage for women to get mammograms starting at 40; although there was a little controversy during the roll out in debate around the plan about that, but at the end of the day coverage was still maintained for that particular services which is very important and certainly something that we are glad to see. The other coverage's do include those for a variety of services and tests related to colon cancer screening. They also provide the screenings for prostate cancer, although this is still a bit controversial at the current time. A couple of other areas that are included are counseling for tobacco. This was not covered necessarily on many plans before, so that's also been included. And there will also be coverage for nutrition counseling. So as the big risk factors of tobacco and those related to nutrition are going to be part of the package.

Lisa Garvin: I think from what I understand that they were also going to cover genetic testing and counseling for women at high risk with the BRCA gene?

Dr. Foxhall: That's correct. So there will be other opportunities as the plan rolls out.

Lisa Garvin: And I know M.D. Anderson has been a proponent of putting out lung screening guidelines, and this is a big deal and it was part of a big paper. Do you foresee lung screenings becoming part of the prevention services menu?

Dr. Foxhall: It's possible. The screening for lung cancer has never been shown to be beneficial in the past, but our recent study looking at screening for lung cancer in high risk individuals, people who have a long smoking history in particular, with a CT scan. Low radiation dose helical CT did show effectiveness in a randomized trial. This has not been reported on by the U.S. Preventive Services Task Force yet, but I'm sure they will be considering that. So at this point it's not a covered benefit, but it would not surprise me if that doesn't become one in the future.

Lisa Garvin: Have we seen an increase in patients seeking prevention services and screening here at M.D. Anderson?

Dr. Foxhall: There has been a gradual increase in the number of patients seen in our cancer prevention center, and this has been a gradual growth over time. The additional coverage with these services under the Affordable Care Act, I think will increase that in the future. The lung screening that we mentioned has been available, and there's been a few individuals who started to take a look at that. I think there is not a broad awareness in the public of this opportunity yet, but as people become more aware of it I would expect that we would see an increase in that as well.

Lisa Garvin: Do you feel like... obviously there's been a lot of ongoing heated rhetoric about healthcare reform. Do you feel like the prevention services success story is getting lost? Is it hard to get the word out that hey, you can get these services now?

Dr. Foxhall: Well there are clearly some good parts of the Affordable Care Act from our point of view, and from the cancer patient's point of view. However there is still quite a bit of debate and argument in the political arenas, and much of it is quite polarized as far as the benefits of having this sort of national health insurance policy. So I'm sure we will continue to hear that, especially as we're in the midst of a presidential campaign, and at some point hopefully the act can be examined in a more objective fashion and we'll be able to see what real benefits are coming in; be able to hopefully address the challenges that it is going to bring to us in the future.

Lisa Garvin: Being a professor of clinical cancer prevention this must be good news to you that healthcare reform is looking at preventive services. We do know that when applied correctly they do work.

Dr. Foxhall: That's exactly right, and the sorts of interventions that we're speaking of today are things that have been shown through scientific study to provide benefit. That means it reduces an individual's chances of getting cancer in the first place, or it gives them an opportunity to find it early so the outcomes are dramatically improved. As we have seen in many, in the cancers where we have objective findings the outcomes are very dramatically different if someone has their cancer detected at an early stage versus at a late stage.

Lisa Garvin: And even though we have lots of prevention awareness campaigns it's still really kind of dissolves to personal responsibility.

Dr. Foxhall: Well it's important for everyone to be aware of the opportunities that they can take to protect themselves from cancer, as well as other chronic diseases in this country. We have fortunately a strong body of evidence that tells us that avoiding tobacco, proper diet and adequate exercise, and utilization of the screening measures we've talking about can significantly reduce an individual's chance of suffering and dying from cancer. The unfortunate situation is that we do not apply these opportunities equally across our population. So in particular some groups are less able to utilize these things that we know help reduce their risk of getting cancer, or dying from cancer. And there are many barriers that we have to try to address. They may be financial, they may be transportation, there may be knowledge barriers still as we continue to try to improve the level of understanding in the public. There are outreach and public education endeavors to help everybody understand that there is clearly benefit to tobacco free living and healthy eating, and using the interventions that we have to reduce their risk of cancer. There is still unfortunately many segments of the population that don't partake of these opportunities.

Lisa Garvin: I do know that M.D. Anderson has done some outreach, what with the mobile mammography program and then they do PSA screenings in the fall. Do you feel like that in some point you have to take the preventive services to them?

Dr. Foxhall: Well the idea is to reduce the barriers to obtaining the services. So to the extent that individuals, particularly if they are individuals who are low income or who may have difficulty taking time off work to get to services that we have, or may have difficulty obtaining the information and education about how they can reduce their cancer risk and protect themselves from cancer. Then it is helpful if we can provide those opportunities out in the community. We've been working through our cancer control program to try to address these challenges, and we've been gradually moving to focus our activities on these primary areas that we've been talking about so that we can provide opportunities through public education, through professional education, reaching out to our community physicians and other health professionals; and also to address policy related issues that may impact these challenges. So how we approach issues such as exposure to tobacco, or the provision of healthy diets and adequate exercise in our community, are equally as important as providing the actual services which we can extend our reach through our mobile van and other approaches to do that as well.

Lisa Garvin: What would be your advice to people who want to seek out these preventive services? What kind of questions do they ask their doctor, how do they go about availing themselves of these services?

Dr. Foxhall: Well it's important for people to understand the approach that can help them reduce their risk of getting cancer, or suffering and dying from cancer through the basic areas of education. So we have significant materials available on our website. We also have printed materials that our public education office makes available through various community events, and through our regional care centers and other opportunities in the community. And we try to make these available in languages other than English if the populations are more comfortable getting information in that fashion as well. We've attempted to provide additional education through our Faculty Speakers Bureau, and through our various conferences to our professional colleagues in the community; both here in Houston and across the country to help them improve their knowledge and understanding of the preventive opportunities that they can help provide their patients. And we also reach out and work with a number of community organizations such as the Cancer Society or Lance Armstrong Foundation, or the Coleman Foundation and many, many others as well as groups related to our federally qualified health centers, our city and county public health departments, our state health department to carry these messages as partners. This is not a job that anybody can do alone, and we think it's important that we go hand in hand with our colleagues in public health, and public education, and professional education to take these messages to the public and to the professional community so that we can all work together to try to do a better job of helping people take advantage of these opportunities.

Lisa Garvin: I think that sums it up quite nicely. Thank you.

Dr. Foxhall: Thank you.

Lisa Garvin: If you have questions about anything you've heard today on Cancer Newsline, contact ask M.D. Anderson at

1-877-MDA-6789, or online at Thank you for listening to this episode of Cancer Newsline. Tune in

for the next podcast in our series.

[ Music ]