Study Shows ACA Coverage Expansion Resulted in Increased Cervical Cancer Diagnosis at Early Stage in Young Women

Key Points

  • Women aged 21 to 25 years had net increases in diagnosis at an early stage and receipt of fertility-sparing treatment compared with those aged 26 to 34 years.
  • The proportion of younger women with diagnosis of breast cancer at an early stage increased from 67.9% in 2009 to 84.3% in 2011 and then decreased to 72.3% in 2012.

In a study reported in a research letter in JAMA, Robbins et al found evidence that the Affordable Care Act Dependent Coverage Expansion (ACA-DCE) has resulted in increased diagnosis of cervical cancer at an early stage and increased use of fertility-sparing treatments in women aged 21 to 25 years. The DCE, which went into effect in September 2010, permits young adults to remain on parental insurance plans until the age of 26 years.

Study Details

The study involved analysis of National Cancer Data Base data on 3,937 first primary cervical cancer cases diagnosed before DCE (January 2007–December 2009) and 2,480 cases diagnosed after DCE (January 2011–December 2012) among women aged 21 to 25 years (DCE-eligible) and those aged 26 to 34 years. Early disease was defined as stage I or II, and late disease was defined as stage III or IV.

Changes From Pre- to Post-DCE

Overall, patients with private insurance were more likely than those with Medicaid or no insurance to be diagnosed with early-stage disease (77.8%, 64.7%, 67.0%; P < .001) and more likely to receive fertility-sparing treatments (23.6%, 12.2%, 16.7%; P < .001).

For the pre-DCE vs post-DCE periods, women aged 21 to 25 years had net increases of 9.0 percentage points in diagnosis of early-stage disease (P = .01) and 11.9 percentage points in receipt of fertility-sparing treatments (P = .002) compared with those aged 26 to 34 years. Among those aged 21 to 25 years, the proportion of cases that were early-stage disease increased from 67.9% in 2009 to 84.3% in 2011 and then decreased to 72.3% in 2012. The proportion of these women receiving fertility-sparing treatment increased throughout the study period, from approximately 22% in 2009 to 39% in 2012.

The investigators concluded: “Although based on early data,… these findings suggest an association between the ACA-DCE provision and cervical cancer stage at diagnosis and receipt of fertility-sparing treatment among young women aged 21 to 25 years…. However, the increase in proportion of early-stage disease 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 increase in rates of fertility-sparing treatment after the ACA may reflect continuation of a pre-ACA trend.”

The study was supported by the American Cancer Society.

Xuesong Han, PhD, of the American Cancer Society, Atlanta, Georgia, is the corresponding author of the JAMA article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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