The landscape for the screening of colorectal cancer (CRC) has witnessed multiple triumphs over the past decades from policy-level interventions. In the United States (US), the most prominent intervention of this nature is the Patient Protection and Affordable Care Act (ACA), enacted more than a decade ago. Since its enactment, the ACA has seen multiple legal challenges, and its impact on CRC screening has been relatively well studied. However, a consolidated, concise analysis of the data on this subject is lacking. Herein, we evaluate the impact of the ACA on CRC screening through the lens of a policy analysis, highlighting its strengths and shortcomings, and suggest policy-level interventions to address these shortcomings and improve CRC screening adoption.

Background/Objectives: The associations of statins and testosterone replacement therapy (TTh) with the risk of obesity-related cancers (ORC, breast [BrCa], colorectal [CRC], ovarian, and endometrial cancers) in older women remain poorly understood. This study examined the associations between the use of statins and TTh with risk of ORC and its cancer-specific sites in women aged 65 years and older. Methods: A retrospective cohort study was conducted using 2007–2015 SEER-Medicare data, including 142,772 women aged ≥ 65 years. We identified 52,086 women with incident ORC (BrCa [n = 32,707], CRC [n = 11,070], ovarian [n = 2601], and endometrial [n = 5708] cancers). The primary exposures were use of statins and TTh. Weighted multivariable time-dependent Cox proportional hazards and models were conducted to estimate hazard ratios (HRs) of incident ORC. Results: We found an inverse association of statins with incident [HR, 0.76; 95% CI: 0.74, 0.78], high-grade [HR, 0.75; 95% CI: 0.72, 0.78], and advanced-stage [HR, 0.91; 95% CI: 0.88, 0.95] ORC. Concurrent use of statins and TTh was associated with a reduced incidence of ORC and high-grade ORC. Similar associations were observed with BrCa. Statins were inversely associated with high-grade ovarian cancer and endometrial cancer (incident, high-grade, and advanced-stage). Conclusions: Use of statins was inversely associated with ORC, BrCa, and endometrial cancer (high-grade and advanced-stage) and high-grade ovarian cancer in older women. Concurrent use of statins and TTh was inversely associated with ORC and BrCa and their high-grade disease. Future prospective studies are needed to substantiate these findings, especially with a focus to examine time– and dose–response associations and to identify underlying biological mechanisms through which statins and TTh influence incidence of ORC.

Objective: This study evaluated the association between antiobesity medications (AOM) and incident cardiovascular disease (CVD) among older women, examining this relationship within and across survivors of obesity‐related cancers (ORCa) and age‐matched cancer‐free populations. Methods: We conducted a retrospective cohort study using SEER–Medicare data from 2007 to 2015. The study included 46,552 women aged ≥ 65 years: ORCa survivors ( n = 23,276) and age‐ and index‐matched cancer‐free women ( n = 23,276). Prediagnostic AOM prescriptions before CVD onset were examined using intent‐to‐treat (ITT) and per‐protocol approaches. Multivariable Cox proportional hazards models estimated hazard ratios (HR) and 95% CI for incident CVD. Results: In ITT analyses, AOM use was associated with lower CVD incidence in the composite analytic sample (HR = 0.80, 95% CI: 0.71–0.90) and among cancer‐free women (HR = 0.70, 95% CI: 0.58–0.85). Among ORCa survivors, estimates suggested a similar direction but were not statistically significant. In per‐protocol analyses, AOM use was associated with reduced CVD risk in ORCa survivors (HR = 0.74, 95% CI: 0.57–0.94) and cancer‐free women (HR = 0.59, 95% CI: 0.45–0.77). These associations were more pronounced within the first 2 years of follow‐up. Conclusions: AOM use was inversely associated with incident CVD among ORCa survivors and cancer‐free women. Further studies of second‐generation AOM, particularly glucagon‐like peptide‐1 receptor agonists, are warranted.