By cutting patients’ out-of-pocket expenses for screening mammography, the Affordable Care Act succeeded in sending many more women for the exams. Now comes a review of Medicare claims revealing that the effect was nowhere to be found in the target population for screening colonoscopy.

The juxtaposition suggests that, when it comes to promoting preventive services that may save U.S. healthcare much money over the long haul, patient affordability matters—but it doesn’t fully suffice.

The numbers were crunched at Case Western Reserve University in Cleveland, where Gregory Cooper, MD, and colleagues drew from a 5 percent random sample of Medicare claims filed between 2009 and 2012 for people who were 70 or older and due for screening.

They examined claims for screening mammography and screening or surveillance colonoscopy for two years prior to the rollout of Obamacare (2009 to 2010), when out-of-pocket costs were substantial, and two years into its run (2011-2012), when the wallet wounds were little to none.

In all, the team reviewed claims data on 862,267 women due for mammography screening against 326,503 individuals due for screening or surveillance colonoscopy, all of whom had one or more increased risk factors for colorectal cancer.

They found that, compared with 2009, there was an increase in screening mammography exams during the ACA coverage period, with multivariable odds ratios (MOR) of 1.22 for 2011 and 1.17 for 2012, along with less change in 2010 (MOR of 1.03).

By contrast, screening or surveillance colonoscopy actually decreased in 2012 (MOR of 0.95) compared with 2009, with no change in 2010 (MOR of 1.01) or 2011 (MOR of 1.01).  

Looking at just patients between 70 and 74 years old, the researchers found that colonoscopy increased slightly in 2011 for this cohort but was unchanged in 2012.

Meanwhile, the findings by year for mammography were consistent with the main analysis.

A Dec. 15 news release from University Hospitals Case Medical Center notes that Cooper et al. additionally found a greater uptake in colonoscopy among patients who participated in a yearly wellness visit with their primary care physician.

The authors hypothesize this may owe to the fact that such visits include a required written screening schedule for five to 10 years and so could be “effectively facilitating referrals” for these tests.

“This study reinforces that we need to do more than simply issue national guidelines for colorectal cancer screenings and make them affordable for everyone in the target population,” Cooper said in prepared remarks.

The study was e-published Dec. 6, ahead of its print publication in the May 2016 edition of the Journal of the National Cancer Institute.