More young women in the USA with cervical cancer are having fertility-sparing treatment due to earlier diagnosis.
Research by the American Cancer Society shows the proportion of cervical cancer diagnoses made at an early stage among women aged 21–25 years increased from 71 percent in 2007–2009 to 79 percent in 2011–2012. The researchers suggest this may be due to the Affordable Care Act (ACA), also known as Obamacare, which came into effect in September 2010.
The ACA allows those aged under 26 to stay on their parents' health insurance, and since it was introduced, around four million more people aged 19–26 have medical coverage. The researchers argue that this could have increased detection rates for this age group, as most health insurance plans cover cervical screening from the age of 21.
The team found that earlier detection has led to an increase in women in this age range who are able to have less aggressive treatment for their cancer. In the period 2007–2009, 26 percent of women were eligible for fertility-sparing treatment. This increased to 39 percent in 2011–2012.
Authors, Dr Xuesong Han and colleagues, explain that when the cancer is detected early it can be treated with more minor surgery which preserves the uterus. If detected in the later stages, women often need more invasive treatments such as a hysterectomy, along with chemotherapy and radiotherapy which all have negative effects on fertility.
The study, published in JAMA, used anonymous data from the National Cancer Data Base. The database contains information for around 70 percent of all cancer cases in the USA. The researchers compared two groups of women diagnosed with cervical cancer, those aged 21–25, eligible for expanded medical coverage under ACA, and those aged 26–34. In the older group of women, early-stage diagnosis stayed flat, at 73 percent in 2007–2009 and 71 percent in 2011–2012.
However, the authors note that the study does not have enough evidence to make a definitive link between the ACA and the increased early treatment for cervical cancer, and the findings could also be due to random fluctuation.