By Shereen Lehman
(Reuters Health) – Under the Affordable Care Act (ACA) provision allowing adult children to stay on their parents’ health insurance policy until age 26, young women with gynecological cancers were diagnosed and treated sooner, researchers say.
Before the law, often called Obamacare, went into effect, one in three women aged 19 to 26 years had health insurance, and today more than four in five women in this age group are insured, the study team notes in Obstetrics & Gynecology.
In a comparison of young women who would have had access to insurance coverage under the law, and slightly older women who would not have had the same access, researchers found that 3.6 percent more of the younger group had their cancers diagnosed at an early stage.
“Each year in the U.S., several thousand young women are diagnosed with gynecological cancers, including cervical, endometrial, ovarian and vulvovaginal cancers,” the study’s authors, Drs. Anna Smith and Amanda Fader, told Reuters Health in an email.
“We know that diagnosing and treating women in the earlier stage of disease helps them live longer and healthier, which is particularly important for young women. However, prior to the ACA, young people were more likely to be uninsured than any other group of Americans,” said Smith and Fader, both gynecologists at Johns Hopkins School of Medicine in Baltimore.
Although cancer is diagnosed less frequently in young adults compared with older people in the U.S., it’s a leading cause of death in this population, Smith and Fader said.
“Additionally, while the incidence of many types of cancer in the U.S. is plateauing or decreasing, the incidence of some gynecologic cancers and pre-cancers is increasing. This means that more younger women are potentially susceptible,” they noted.
For example, because endometrial cancer is strongly associated with obesity and there is a major obesity epidemic in the U.S. and globally, we are seeing the incidence of this cancer rise over the last two decades, and more women under the age of 45 are being diagnosed, Smith and Fader said.
For their study, the researchers analyzed data from a national cancer database. They included in the analysis women aged 21 to 35 diagnosed with uterine, cervical, ovarian, vulvar or vaginal cancer during the years 2004 to 2009, before the ACA went into effect, and 2011 to 2014, after the ACA went into effect.
Among women diagnosed at ages 21 to 26, the study team identified a total of 1,912 gynecologic cancer cases before the ACA and 2,059 during the ACA, and among women diagnosed between 27 and 35, there were 9,782 cases before ACA and 10,456 cases during the ACA.
In addition to the younger women being more likely to be insured and diagnosed when their cancer was at an earlier stage, women in both age groups were more likely to receive fertility-sparing cancer treatments during the ACA years, the study found.
“This study adds to the evidence of the positive effects of improved coverage through the ACA on young women’s healthcare costs and choices,” Dr. Laura Havrilesky, a gynecologist at Duke University Medical Center in Durham, North Carolina, writes in an editorial accompanying the study.
“This is an important study looking at the effects of the Affordable Care Act on insurance coverage in young women with a cancer diagnosis,” Havrilesky told Reuters Health in an email.
The immediate extension of insurance coverage to dependents under age 26 by the ACA in 2010 resulted in improved insurance coverage rates and earlier stage at diagnosis of uterine cancer in young women aged 21 to 25, she added.
“This is important because younger women with low-stage cancer can sometimes be candidates for fertility-sparing surgery,” Havrilesky said.
Young women have traditionally faced discriminatory insurance practices such as higher insurance premiums than men at the same age and denial of maternity care coverage, she noted.
“The ACA has resulted in a measurable reduction in the rate at which women skip recommended screening and prevention tests as well as a huge savings from improved oral contraceptive coverage,” Havrilesky said.
These are just two examples of areas where the coverage of young women ultimately affects the entire population, she said.
SOURCE: https://bit.ly/2IjhvdF and https://bit.ly/2rLzXQT Obstetrics and Gynecology, online May 7, 2018.
