July 24, 2012

Cervical Cancer: Late Diagnosis For the Uninsured

(Ivanhoe Newswire) -- Imagine finding out you had a severe stage of cervical cancer. Now imagine that the only reason behind this late diagnosis is your inability to afford an annual doctor checkup. New findings suggest that the lack of insurance is second only to age as the strongest predictor of late stage diagnosis.

The American Cancer Society estimates that 12,170 women will be diagnosed with cervical cancer and 4,220 women will die from the disease in 2012. Although incidence and mortality from cervical cancer have declined dramatically since the introduction of the Pap test, one in three cervical cancer patients is diagnosed only after the cancer has spread to nearby organs and one in ten is diagnosed only after the disease has spread to distant organs. Prognosis is strongly related to stage: the 5-year relative survival rate is 91.2% for patients with localized disease, but only 57.8% for patients with regional disease and 17.0% for those with distant disease.

"If the tumor is confined to the organ, it is more localized and you don't have to really involve radiation. It is much easier to treat something that is confined and hasn't yet spread," Stacey Fedewa, epidemiologist, MPH, told Ivanhoe.

Socioeconomic status, race, marital status, and geographic location have all been identified as factors related to late stage at diagnosis among cervical cancer patients. Previous studies also documented age as a significant predictor of advanced stage, although the effects of age and insurance status (which are two of the strongest predictors of cervical cancer screening) had not been studied together prior to the current study.

Research led by Stacey Fedewa reviewed the association between late stage (stage III/IV) cervical cancer and both insurance and age, with adjustment for race/ethnicity and other socio-demographic and clinical factors on 69,739 women diagnosed with invasive cervical cancer.

More than half of privately insured cervical cancer patients in the observed population were at stage I at diagnosis, compared to 40.2% of Medicaid recipients, and 36.4% of uninsured patients. Meanwhile, 24.03% of privately insured women, 34.51% of those with Medicaid, and 35.22% of those without insurance were diagnosed with advanced disease, described as stages III and IV. Advanced stage also increased with age.

Advanced-stage disease leads not only to poorer quality of life and greater morbidity, but often to higher treatment costs as well. Screening should be made accessible and affordable for all women for whom it is recommended, especially for those at higher risk of advanced-stage disease.

"The National Breast and Cervical Cancer Early Detection Program, which is congress funded and run by the CDC, provides free breast and cervical cancer screenings as well as treatment if you are diagnosed. It is a really great resource that is definitely underutilized by women," Stacey concluded.

Source: Interview with Stacey Fedewa, Epidemiologist, MPH, and The American Journal of Public Health, July 19, 2012