July 19, 2012 -- Women without health insurance are far more likely to receive a diagnosis of advanced cervical cancer, a new study from the American Cancer Society shows.
Lack of health insurance was second only to age as the strongest predictor of advanced-stage disease.
Once a leading cancer killer of women, deaths from cervical cancer in the United States dropped dramatically after Pap test screening became a common practice.
But about 1 in 3 cervical malignancies are still diagnosed after the cancer has spread outside the cervix, and 1 in 10 is found in the disease's latest stages, when treatment is far less likely to lead to a cure.
About 90% of women diagnosed with early-stage disease live for five years or longer after the cancer is diagnosed, compared to less than 20% of women diagnosed in the latest stages, when their disease has spread to distant organs.
Older age, race, and economic status have long been identified as risk factors for advanced cervical cancer diagnosis, and lack of health insurance is a well recognized barrier to Pap test screening.
But the new study is among the first to examine the impact of health insurance status on disease stage at diagnosis in a large, nationally representative group of women.
Researchers with the American Cancer Society (ACS) reviewed the medical histories of close to 70,000 women whose newly diagnosed cervical cancers were reported to the National Cancer Database between the years 2000 and 2007.
They found that:
Just over half of the women (55%) who had private health insurance had a stage I diagnosis, compared to 36% of women who were uninsured. Twenty-four percent of privately insured women were diagnosed with advanced disease (stage III and IV), compared to 35% of uninsured women.
Economically disadvantaged women covered by Medicaid had rates of late-stage diagnosis similar to that of uninsured women.
Older age was still the strongest predictor of late-stage disease, though, with risk being up to 2.5 times greater in women 50 years and older compared to women 21 to 34 years of age.
American Cancer Society epidemiologist Stacey Fedewa, MPH, says it is common for screening to decline or stop altogether when women approach the age of menopause.
ACS recommends that:
All women begin cervical cancer screening by the age of 21, and that women between the ages of 21 and 29 have a Pap test every three years.
Women between the ages of 30 and 65 have a Pap test and a human papillomavirus (HPV) test every five years or a Pap test alone every three years.
Women over the age of 65 who have had regular screenings should not continue screening unless they have had abnormal results indicative of an increased risk for the cancer.