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ACA leads to earlier detection of gynecologic cancers among young women
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Younger women with gynecologic cancer appeared more likely to be insured and diagnosed at an early stage under the Affordable Care Act’s dependent coverage mandate, according to findings published in Obstetrics & Gynecology.
“As the debate on how we insure women goes on, reminding ourselves that these insurance gains have huge impacts on people’s lives is the big takeaway here,” Anna Jo Bodurtha Smith, MD, MPH, gynecology and obstetrics resident at Johns Hopkins University School of Medicine, said in a press release.
Since implementation of the dependent coverage mandate in September 2010 — which states young adults can stay on a parent’s private insurance through 26 years of age — 8 million young adults have remained on a parent’s coverage.
Thus, before ACA implementation, one in three women aged 19 to 26 years were reportedly uninsured. After ACA implementation, less than one in five women aged 19 to 26 years were uninsured.
Access to consistent and high-quality health insurance under the ACA may decrease delays in seeking care and improve gynecologic cancer outcomes; however, the effect of the ACA dependent mandate among women with gynecologic cancer had remained unknown.
Smith and Amanda Fader, MD, associate professor of gynecology and obstetrics at Johns Hopkins University School of Medicine, used data from the National Cancer Database to compare women aged 21 to 26 years with women aged 27 to 35 years diagnosed with uterine, cervical, ovarian, vulvar or vaginal cancers between 2004 and 2009 — prior to implementation of the ACA — or between 2011 and 2014, after implementation.
Among women aged 21 to 26 years, researchers identified 1,912 gynecologic cases before implementation and 2,059 cases after. Among women aged 27 to 35 years, researchers found 9,782 cases before implementation and 10,456 cases after.
Researchers used a difference-in-differences approach to analyze trends between insurance coverage, stage at cancer diagnosis and receipt of fertility-sparing treatment before and after the ACA between the two age groups. Researchers also measured outcomes for women overall and by cancer and insurance type, adjusting for race, nonrural area, and area-level household income and education level.
After the ACA, women aged 21 to 26 showed a trend toward a decrease in uninsurance, but this did not reach statistical significance.
However, the ACA was associated with a significant decrease in uninsurance among women aged 21 to 26 years compared with women aged 27 to 35 years in the difference-in-differences analysis (2.2%; 95% CI 4 to 0.1).
Earlier stage at diagnosis was more common among women aged 21 to 26 years after the ACA (P = .001), but this association did not occur among older women. The difference-in-differences model showed a significant increase in early-stage diagnosis of gynecologic cancer among younger women (3.6%; 95% CI 0.4-6.9).
“We were pleased to see that there was a significant improvement in capturing more women’s cancers early,” Fader said. “It can take decades to observe changes in population-based health trends, so to see differences this soon is promising.”
Early-stage diagnosis of endometrial cancer increased significantly under the ACA among younger vs. older women (difference-in-differences = 10.1%; 95% CI, 0.4-6.9), but researchers observed no significant differences for other cancer types.
Fertility-sparing treatment was used more frequently among women aged 21 to 26 years (P = .004) and women aged 27 to 35 years (P = .001) after ACA implementation. Researchers observed no significant difference in fertility-sparing treatment between age groups in the difference-in-differences model (51.8%; 95% CI, 21.2 to 4.7).
“Although receipt of fertility-sparing cancer treatment increased significantly for women in both
age groups, we did not find a significant improvement in fertility-sparing treatment related to the ACA’s dependent coverage mandate,” Smith and Fader wrote.
Throughout the study period, privately insured women had a tendency to be diagnosed at an earlier stage and appeared more likely to receive fertility-sparing treatment than publicly insured or uninsured women (P < .001).
“We know if these women are identified early and treated early, they are much more likely to live longer and have their cancer go into remission,” Smith said. – by Melinda Stevens
Disclosures: Smith and Fader report no relevant financial disclosures.
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