Both the stage of cervical cancer at diagnosis and the receipt of fertility-sparing treatment among young women age 21 to 25 years, but not among women aged 26 to 34 years, is associated with the Affordable Care Act Dependent Coverage Expansion provision. This finding, based on early data, was published in JAMA (2015; doi:10.1001/jama.2015.10546).
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 diagnosis is 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, PhD, of the American Cancer Society, Atlanta, Georgia, 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 have early-stage disease at diagnosis (78% with private insurance vs 65% Medicaid and 67% uninsured) and more likely to receive fertility-sparing treatments (24% with private insurance vs 12% with Medicaid and 17% uninsured).
Between the pre- and post-DCE periods, compared with 26- to 34-year-olds, women age 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% in 2009 to 84% in 2011 and decreased to 72% 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 age 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,” stated the authors.