The diagnosis of gynecologic cancers in young women is occurring at earlier stages because of implementation of the Affordable Care Act (ACA), according to results of a recent analysis.¹

The five main types of gynecologic cancer are cervical, ovarian, uterine, vaginal, and vulvar. According to the Centers for Disease Control and Prevention (CDC), about 89,000 women per year are diagnosed with a gynecologic cancer. More than 29,000 per year will die from the disease, the CDC estimates.² Each year, about 2,000 women younger than 26 years of age are diagnosed with a gynecologic cancer.³

To perform the current analysis, researchers looked at the National Cancer Database, which contains about 70% of the new cancer diagnoses in the United States. The scientists assessed women 21-26 years of age compared to a group of women 27-35 years of age. Women included in the analysis received a gynecologic cancer diagnosis between 2004 and 2009, before the legislation took effect, or between 2011 and 2014, after the healthcare law was implemented.

The researchers also reviewed how insurance coverage was associated with the stage of cancer diagnosis and receipt of treatment that protected fertility. Investigators adjusted for factors that may affect healthcare access, such as race, household income, and education level.

Researchers identified about 1,900 gynecologic cancers in women ages 21-26 prior to the ACA, compared to 2,059 in women following ACA implementation. In women ages 27-35, 9,782 cases were logged prior to the ACA, with 10,456 cases counted following implementation. When numbers were adjusted for factors such as education and income, data indicate that rates of those without insurance decreased and the diagnosis of cancer at early stages in younger women increased.

Prior to the law, 56.2% of women ages 21-26 were diagnosed with cancer at an early stage, compared to 61.2% following the law’s implementation. Early-stage diagnosis did not change significantly in the comparison group, the researchers noted. For women in both age groups, the use of treatments that spare fertility increased: from 38.2% to 43.2% in young women, and from 17.6% to 20.6% in the comparison group.¹

“We were pleased to see that there was a significant improvement in capturing more women’s cancers early,” says Amanda Fader, MD, associate professor of gynecology and obstetrics at the Johns Hopkins University School of Medicine and a senior author of the new study. “It can take decades to observe changes in population-based health trends, so to see differences this soon is promising.”

“We know if these women are identified early and treated early, they are much more likely to live longer and have their cancer go into remission,” noted Anna Jo Bodurtha Smith, MD, MPH, a resident in gynecology and obstetrics at the Johns Hopkins University School of Medicine and first author of the paper.

Earlier Diagnoses Are Key

Estimates indicate that implementation of the ACA led to an increase in health insurance premiums of 2.5% to 2.8%.⁴ However, the cost to the U.S. economy for early deaths from gynecologic cancer is more than $2 billion per year.¹

The costs of treatment for gynecologic cancers vary: for cervical cancer, the leading gynecologic cancer in young women, costs range from $25,000 to more than $500,000, with costs escalating for the required surgery, chemotherapy, and radiotherapy to treat advanced cases of the disease.⁵ Finding and treating cancer at an early stage saves lives and reduces healthcare costs, says Fader.

“Survival rates improve dramatically when precancer or cancer is identified when the disease is confined to the organ of origin,” noted Fader in a statement. “The cancer is much more likely to be treated successfully, and in the case of reproductive cancers, the potential to preserve fertility and the option of having children can be realized for more women.”

Clinicians should talk with women about symptoms of gynecologic cancer, which can vary among women and by type of disease. Abnormal vaginal bleeding or discharge is common for all types of gynecologic cancers except vulvar cancer, while feeling full too quickly, having difficulty eating, or feeling bloated are common only for ovarian cancer.

Women with ovarian or uterine cancer often experience pelvic pain or pressure, while the need to urinate frequently or urgently and/or constipation are common for cancer of the ovary or vagina. Vulvar cancer involves symptoms such as pain, tenderness, itching, or burning of the vulva, and changes in the color or skin of the vulva, such as a rash, sores, or warts.² 

REFERENCES

1. Smith AJB, Fader AN. Effects of the Affordable Care Act on young women with gynecologic cancers. Obstet Gynecol 2018;131:966-976.
2. Centers for Disease Control and Prevention. Inside Knowledge: Get the Facts About Gynecologic Cancer. Available at: https://bit.ly/2spMaeo. Accessed Aug. 16, 2018.
3. Eskander RN, Randall LM, Berman ML, et al. Fertility preserving options in patients with gynecologic malignancies. Am J Obstet Gynecol 2011;205:103-110.
4. Depew B, Bailey J. Did the Affordable Care Act’s dependent coverage mandate increase premiums? J Health Econ 2015;41:1-14.
5. Chesson HW, Ekwueme DU, Saraiya M, et al. Estimates of the annual direct medical costs of the prevention and treatment of disease associated with human papillomavirus in the United States. Vaccine 2012;30:6016-6019.