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ACA coverage expansion linked to earlier cervical cancer diagnosis among younger women
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More women aged 21 to 25 years were diagnosed with early-stage cervical cancer and received fertility-sparing treatments after the Affordable Care Act Dependent Coverage Expansion went into effect in 2010, according to findings from an American Cancer Society study.
The Affordable Care Act Dependent Coverage Expansion (ACA-DCE) — which commenced on Sept. 23, 2010 — allowed for young adults to remain on their parents’ health insurance plans until age 26 years.
Xuesong Han
Cervical cancer screening has been recommended for women aged 21 years or older by the American College of Obstetricians and Gynecologists since 2009, because diagnosis at an earlier stage allows use of fertility-sparing treatments.
“The Dependent Coverage Expansion under the Affordable Care Act increased the insurance coverage among young adults aged 19 to 25 years, who historically had the highest uninsured rate before the ACA,” Xuesong Han, PhD, director of surveillance and health services research at the American Cancer Society, told HemOnc Today. “Our data suggest it worked in catching cervical cancer at an early stage and providing young patients with fertility-sparing treatment.”
Han and colleagues compared the changes in cervical cancer stage at diagnosis and initial treatment in young women in two age groups — those aged 21 to 25 years who are ACA-DCE eligible, and those aged 26 to 34 years, or who are not eligible.
The investigators used the National Cancer Data Base to identify women aged 21 to 34 years with a first primary invasive cervical cancer. Researchers examined cancer stage at diagnosis in two different time frames — the 3 years prior to the ACA-DCE (2007-2009) and the 2 years following it (2011-2012). The year 2010 was excluded because it was considered a “phase-in” period for the expansion.
The researchers identified 3,937 women diagnosed before the ACA-DCE and 2,480 women diagnosed afterward.
Patients with private insurance (77.8%) were more likely to be diagnosed with early-stage disease than those with Medicaid (64.7%) or who were uninsured (67%; P < .001 for all). Further, privately insured patients (23.6%) were more likely to receive fertility-sparing treatments than those with Medicaid (12.2%) or who were uninsured (16.7%; P < .001 for all).
Overall, the proportion of early-stage diagnoses among women aged 21 to 25 years increased from 67.9% in 2009 to 84.3% in 2011 before dropping back to 72.3% in 2012. Researchers said these changes could attributed to increased access to care or a random fluctuation based on only 2 years of data.
“Since data have shown that the uninsured rate among young adults continues to decline, particularly in Medicaid expansion states, I would expect to see this improvement in early cancer diagnosis and receipt of treatment to continue in young adults for the coming years,” Han said.
The rate of fertility-sparing treatment use among women with invasive cervical cancer increased throughout the study period without fluctuation.
Between the two ACA-DCE periods examined, women aged 21 to 25 years experienced a net increase of 9 percentage points (95% CI, 2.0-16.2) in early-stage disease diagnosis (P = .01) and 11.9 percentage points (95% CI, 4.3-19.5) in receiving fertility-sparing treatments compared with women aged 26 to 34 years (P = .002). These results maintained significance during multivariable analysis.
“With the full implementation in 2014, the ACA further increases insurance coverage for adults of all ages, especially those with a low or middle income,” Han said. “Future studies should continue to monitor cancer care and outcomes in populations targeted by the ACA.” – by Anthony SanFilippo
For more information:
Xuesong Han, PhD, can be reached at xuesong.han@cancer.org.
Disclosure: The researchers report no relevant financial disclosures.
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