Changes in Cervical Cancer Stage at Diagnosis and Initial Treatment Among Young Women Before and After ACA


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Although based on early data, study findings suggest an association between the Affordable Care Act Dependent Coverage Expansion provision and cervical cancer stage at diagnosis and receipt of fertility-sparing treatment among young women age 21 to 25 years, but not among women aged 26 to 34 years, according to a study in the November 24 issue of JAMA.


In September 2010, the Affordable Care Act Dependent Coverage Expansion (ACA-DCE) went into effect, allowing young adults to remain on their parents’ health insurance plans until age 26 years. Implementation of the ACA-DCE was followed by a net increase in private health insurance coverage among young adults age 19 to 25 years. Persons without private health insurance are less likely to be screened and more likely to be diagnosed at an advanced stage of cancer.


Since November 2009, the American College of Obstetricians and Gynecologists has recommended cervical cancer screening begin at age 21 years. Diagnosis of cervical cancer at early stages also allows use of fertility-sparing treatments. Xuesong Han, Ph.D., of the American Cancer Society, Atlanta, and colleagues used data before and after the ACA-DCE to compare changes in cervical cancer stage at diagnosis and initial treatment among women 21 to 25 years (DCE-eligible) and 26 to 34 years (non-DCE-eligible). The National Cancer Data Base, a national hospital-based cancer registry, was used to obtain data on cases of invasive cervical cancer, with stage at diagnosis classified as early (stages I/II) or late (stages III/IV).


The researchers identified 3,937 cervical cancer cases diagnosed pre-DCE and 2,480 cases post-DCE. Patients with private insurance were more likely than those with Medicaid or uninsured to be diagnosed with early-stage disease (78 percent with private insurance vs 65 percent with Medicaid and 67 percent uninsured) and more likely to receive fertility-sparing treatments (24 percent with private insurance vs 12 percent with Medicaid and 17 percent uninsured).


Between the pre- and post-DCE periods, compared with 26- to 34-year-olds, women 21 to 25 years of age experienced a net increase of 9 percentage points in early-stage disease and 11.9 percentage points in receipt of fertility-sparing treatments. Among women age 21 to 25 years, the proportion of early-stage disease increased from 68 percent in 2009 to 84 percent in 2011 and decreased to 72 percent in 2012. The authors note that this increase in 2011 followed by a decrease in 2012 may reflect detection of prevalent early-stage disease associated with increased access to care or random fluctuation.


The proportion of women 21 to 25 years of age receiving fertility-sparing treatment increased throughout the study period.


“Future work should continue to monitor cancer care and outcomes in populations targeted by the ACA.”


(doi:10.1001/jama.2015.10546; Available pre-embargo to the media at http:/


Editor’s Note: This work was supported by the Intramural Research Department of the American Cancer Society. The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.


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