More early cervical cancer cases being detected under Affordable Care Act

There’s no doubt that the Affordable Care Act is a political and economic hot potato, taking blame, just this month, for everything from the insurance industry’s profit losses to craft beer makers possibly going bust over revised nutrition label requirements.

But study results published Tuesday in JAMA highlight a potential upside to the overhaul in health care: young women aged 21 to 25, now covered under the ACA’s Dependent Coverage Expansion program, may be discovering their cervical cancer at an earlier stage.

The study, conducted by researchers with the American Cancer Society, looked at cervical cancer diagnoses in young women both before and after the September 2010 implementation of the ACA-DCE program, which allows young adults to remain on their parents’ health insurance plans until age 26.

“Among women aged 21 to 25 years,” the authors wrote in a research letter, “the proportion of early-stage disease increased from 67.9 percent in 2009 to 84.3 percent in 2011.”

In addition, the authors found that many of the young women were able to receive less-aggressive, fertility-sparing treatment for their early cervical cancer – one of many caused by the human papillomavirus (HPV). Women aged 26 to 34, who were ineligible for the ACA’s DCE program, showed no significant increase in early-stage cervical cancer diagnoses.

‘That’s exactly when you want to catch it’

Dr. Margaret Madeleine, an HPV-related cancer epidemiologist with Fred Hutchinson Cancer Research Center’s Public Health Sciences division, called the finding “preliminary but promising.”

“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.”

Once the leading cause of cancer death for women in the U.S., cervical cancer is now considered highly preventable due to screening tests such as Pap smear (or Pap smear plus HPV co-testing)  – recommended for all women over 21 – and a three-dose HPV vaccine, recommended for 11- and 12-year-old girls and boys. The vaccine is close to 100 percent effective against the HPV types they contain.  Since HPV is a very common infection, nearly all sexually active men and women are exposed to the virus.

“Pap smears can pick up invasive cancers in young women, and you can see that from this study,” said Madeleine. “And now that the HPV vaccine has proven amazingly robust, it’s possible that once vaccine coverage is high enough, screening can occur less frequently. It’s an anti-cancer vaccine and the more people who get anti-cancer vaccines, the less HPV-related cancers we’ll have.”

But the Centers for Disease Control and Prevention termed HPV vaccine adherence rates in the U.S. “unacceptably low” in 2014 and, earlier this year, said the U.S. was still “missing crucial opportunities to protect the next generation from cancers caused by HPV.”

In addition to cervical cancer, HPV can lead to anal, vaginal, penile, vulvar and head and neck cancers. Fred Hutch’s Dr. Denise Galloway played a major role in both discovering HPV’s association with cancer and paving the way for the vaccine.

Currently, about 12,000 U.S. women are diagnosed with cervical cancer every year and around 4,000 women die of the disease. Cervical cancer occurs most often in women over age 30. When found early, it is considered highly treatable and associated with long survival and good quality of life.

“If cancers are caught while they’re still local, the five-year survival rate is 91 percent,” said Madeleine. “Catching these cancers early is really important for survivability and for treatment.”

Early treatment spares lives and fertility

Unfortunately, that treatment – which often starts with surgery – can sometimes means a woman loses her ability to carry a child.

“Sometimes they can take out just part of the cervix and not the whole thing, but hysterectomy [removing the uterus and cervix] can be part of treatment for more advanced cervical cancer,” said Madeleine.

Detecting cervical cancer at an early stage means women live longer – and many can go on to have children after treatment.

“Finding it early through screening is key,” said Madeleine.

In the JAMA study, which used data from the National Cancer Data Base, young women with private insurance were more likely than those who were uninsured or on Medicaid to be diagnosed with early-stage disease. They were also more likely to undergo fertility-sparing treatment, with about twice as many privately insured women receiving fertility-sparing treatment than uninsured women or women on Medicaid.

“It may not be a long-term change; we may not see this increased detection in younger women every year,” Madeleine said of the finding. “We need more years of data and need to see if younger women continue to have increased numbers of cancer. But this study might be important when you’re thinking of the impact of health care being more generally available for younger people.”

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