Researchers found a link between a lack of insurance and having advanced stage cervical cancer at the time of diagnosis when studying a large national sample of women diagnosed with invasive cervical cancer between 2000 and 2007. They note that the link is likely attributable to a lack of screening.
Lack of insurance was secondary only to age as the strongest predictor of a diagnosis of advanced stage disease. Although the incidence and mortality from cervical cancer have declined dramatically since the Papanicolaou test was introduced, approximately 1 in 3 patients with cervical cancer is diagnosed only after the cancer has spread to nearby organs, and 1 in 10 patients is diagnosed only after the disease has spread to distant organs. In addition, the 5-year relative survival rate is 91.2% for patients with localized disease but only 57.8% for patients with regional disease and 17% for those with distant disease.
The study was published online in the American Journal of Public Health, and led by Stacey Fedewa, MPH.1 The investigators, who are American Cancer Society researchers, reviewed the association between latestage cervical cancer and both insurance and age, with adjustment for race/ethnicity and other sociodemographic and clinical factors in 69,739 women from the National Cancer Data Base. Among the factors identified as being related to late-stage diagnosis for patients with cervical cancer are socioeconomic status, race, marital status, and geographic location.
The study found that 55.5% of privately insured patients with cervical cancer in the observed population had stage I disease at the time of diagnosis, compared with 40.2% of Medicaid recipients and 6.4% of uninsured patients. At the same time, 24% of privately insured women and 35.2% of those without insurance were diagnosed with advanced disease. Advanced stage disease at the time of diagnosis also increased with age: the adjusted relative risk among women aged 35 years and older was 1.25 to 2.5 times that of women between the ages of 21 years and 34 years.
Late stage at the time of diagnosis is likely attributable to under screening, the authors note, adding that screening should be made accessible and affordable for all women for whom it is recommended. In particular, these candidates include middle-aged women, Medicaid recipients, and the uninsured.