Absence of Insurance Associated With Advanced-Stage Cervical Cancer Diagnosis

The American Cancer Society estimates that in 2012, 12,170 women will be diagnosed with cervical cancer and 4220 will die of the disease. With cervical cancer, prognosis is strongly related to disease stage: the 5-year relative survival rate is only 57.8% for patients with regional disease and 17.0% for those with distant disease. Now researchers say one of the strongest predictors of a late-stage cervical cancer diagnosis is lack of insurance, which is second only to age as a factor. Study authors believe the results are likely related to lack of screening.

In previous studies, socioeconomic status, race, age, marital status, and geographic location have all been identified as factors related to late stage at diagnosis among cervical cancer patients. However, the consequences of age and insurance status, two of the strongest predictors of cervical cancer screening, had not been studied jointly prior to the current study.

For the current study, published early online in the American Journal of Public Health, researchers examined the records of 69,739 women from the National Cancer Database diagnosed with invasive cervical cancer between 2000 and 2007. The association between late stage (stage III/IV) cervical cancer and both insurance and age, with adjustment for race/ethnicity and other sociodemographic clinical factors, was reviewed.

In the observed population, 55.5% of privately insured patients with cervical cancer were at stage I at diagnosis, compared to 40.2% of those with Medicaid, and 36.4% of uninsured patients. However, 24.03% of privately insured women, 34.51% of Medicaid recipients, and 35.22% of those without insurance were diagnosed with advanced disease. Initial diagnosis at an advanced stage also increased with age. The adjusted relative risk among women 35 years of age or older was 1.25 to 2.5 that of women aged 21 to 34 years.

“Late stage at diagnosis is likely attributable to underscreening,” write the authors. “Advanced-stage disease leads not only to poorer quality of life and greater morbidity, but often to higher treatment costs as well. Screening should be made accessible and affordable for all women for whom it is recommended, especially for those at higher risk of advanced-stage disease, such as middle-aged women, Medicaid recipients, and uninsured women,” they say.

Source: ACS.