WASHINGTON — Cancer researchers say there has been a substantial increase in women under the age of 26 who have received a diagnosis of early-stage cervical cancer, a pattern that they say is most likely an effect of the Affordable Care Act.
Starting in 2010, a provision of the health law allowed dependents to stay on their parents' health insurance until age 26. The number of uninsured young adults fell substantially in the years that followed. The share of 19- to 25-year-olds without health insurance declined to 21 percent in the first quarter of 2014, from 34 percent in 2010 — a decrease of about 4 million people, federal data show.
Researchers from the American Cancer Society wanted to examine whether the expansion of health insurance among young American women was leading to more early-stage diagnoses. Early diagnosis improves the prospects for because treatment is more effective and the chance of remission is higher. It also bolsters women's chances for preserving their fertility during treatment. And women with health insurance are far more likely to get a screening that can identify cancer early.
Researchers used the National Cancer Data Base, a hospital-based registry of about 70 percent of all cancer cases in the United States. They compared diagnoses for women ages 21 to 25 who had cervical cancer with those among women ages 26 to 34, before and after the health law provision began in 2010. Early-stage diagnoses rose substantially among the younger age group — the one covered by the law — and stayed flat among the older group.
About 79 percent of the younger group had an early-stage diagnosis in 2011-12, up from about 71 percent in 2007-09. For the older group, the percentage dropped to 71 percent from 73 percent, a change that is not statistically meaningful.
The study was not aimed at proving that the change was a direct result of the law. But the size of the database, and the fact that the share of young women with health insurance had increased so substantially, led researchers to conclude that the law was having an effect. (Pap tests are a part of most routine medical checkups for young women.)
"It's a very remarkable finding, actually," said Dr. Ahmedin Jemal, one of the researchers. "You see the effect of the ACA on the cancer outcomes."
The effect for younger women looked even stronger when analyzed by year. About 84 percent of the younger group had early-stage diagnoses in 2011, compared with 68 percent in 2009. Early-stage diagnoses dropped to 72 percent of the group in 2012, a drop that Jemal said was typical during increases in screenings, because many of the early-stage cases have already been detected.
For several years, researchers have been trying to test whether the law is working to improve health, but isolating its effects has been tricky. A study this spring found that the number of new diabetes cases identified among poor Americans had surged in states that embraced the Affordable Care Act, but not in states that had not.
Since November 2009, the American College of Obstetricians and Gynecologists has recommended that cervical cancer screening begin at age 21, the only cancer screening recommendation for that age group. Jemal said that change made it impossible to compare the total number of women who got screened before and after the health care law came into effect.