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ACA coverage expansion has led to earlier detection of cervical cancer, study suggests

Each year, about 12,000 women are diagnosed with cervical cancer in the U.S., and about 4,000 die of the disease.

Here’s something we can be grateful for this Thanksgiving weekend: A new study reports that increasing numbers of young women with cervical cancer are having the disease diagnosed earlier than in the past — at a stage when the cancer is highly treatable.

And it appears we may have the Affordable Care Act to thank for this life-saving trend.

Cervical cancer screening is one of the great successes of modern medicine. Before the Papanicolaou (Pap) screening test was developed in the 1940s, cervical cancer was a leading cause of death among women of childbearing age in the United States. That death rate has since fallen by more than 60 percent.

Yet cervical cancer still poses a deadly threat to women, particularly when it’s not caught in its earliest stages. Each year, about 12,000 women are diagnosed with cervical cancer in the U.S., and about 4,000 die of the disease, according to the Centers for Disease Control and Prevention.

Before and after ACA

For this new study, which was published Tuesday as a research letter in the Journal of the American Medical Association (JAMA), researchers from the American Cancer Society (ACS) used data from the large National Cancer Data Base to compare the rates of cervical cancer diagnoses in American women aged 21 to 25 before and after September 2010. That is the date when the Affordable Care Act’s Dependent Coverage Expansion (ACA-DCE) program began allowing young adults to be on their parents’ health insurance plans until the age of 26.

Cervical cancer screening is a routine part of the annual medical checkup for women, and is covered by insurance providers. Current guidelines recommend that women start getting regular Pap tests at age 21.

After examining the data, the researchers found that in the two years (2007-2009) prior to the ACA’s 2010 insurance expansion, 71 percent of cervical cancers in women aged 21 to 25 were diagnosed early (at stage 1 or 2). In the two years after the expansion (2011-2012), that percentage jumped to 79 percent.

But among women aged 26 to 34 — a group not covered under the ACA-DCE program — the rate of early diagnosis remained essentially flat during those years, rising from 71 percent to 73 percent.

Interestingly, the biggest increase in early diagnoses among the 21- to 25-year-olds occurred in 2011, the first year after implementation of the ACA-DCE program. About 84 percent of women aged 21 to 25 had early-stage diagnoses in 2011, compared with 68 percent in 2009. In 2012, the proportion of early-stage diagnoses among this group dropped to 72 percent.

As one of the study’s authors told the New York Times, the 2012 percentage drop would be expected, given that many of the early-stage cancers would have been detected in this age group during the first year of the women’s insurance eligibility.

The data also revealed that after 2010, women in the 21 to 25 age group were significantly more likely to be eligible for less aggressive treatments, which usually allow them to avoid a hysterectomy and, thus, have children in the future. In 2011-2012, 39 percent of cervical cancer patients in this age group underwent fertility-sparing treatment, compared to just 26 percent in 2007-2009.

‘Preliminary but promising’

This study cannot prove that the Affordable Care Act directly led to more young women having their cervical cancer diagnosed at an earlier, more treatable stage. For, as Dr. Margaret Madeleine, a cancer epidemiologist with the Fred Hutchinson Cancer Research Center who was not involved in the study, told a reporter for her organization’s news service, these findings are only “preliminary.”

But they are also promising, she added. “What they saw right away in 2011 was this bump in diagnoses in early invasive cervical cancer — and that’s exactly when you want to catch it with screening,” she said. “This observation supports the idea that women who might not have been picked up with a cancer until they were older might be getting picked up earlier. That’s fabulous because earlier cancers require less extensive treatment.”

You’ll find an abstract for the study on the JAMA website, but the full study is behind a paywall.

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