A team of investigators found that, following the closure of nearly 100 women's health clinics across the U.S. from 2010 to 2013, fewer women were screened for cervical cancer, more women were diagnosed with advanced stages of the disease, and mortality rates rose.
"Reducing the availability of cervical cancer screening has very real, negative consequences for women," noted lead author Dr. Amar Srivastava of Washington University School of Medicine in St. Louis in a statement released by ASTRO.
Cervical cancer was one of the major causes of death for women through the 1940s, a trend that was reversed with the arrival of the Pap smear screening test in the 1950s. When diagnosed early, cervical cancer is amenable to treatment -- even so, more than 13,000 new cervical cancer cases are still diagnosed and 4,250 deaths from the disease occur each year, according to ASTRO.
But the progress being made against cervical cancer appears to be slipping. Cervical cancer screening has gotten caught up in the debate over family planning in the U.S., as Pap smears are often provided in the same centers that provide services such as abortion. Many of these centers have closed due to changes in state and federal regulations, as well as funding cuts from programs such as Title X program, which provides federal funding for clinics that provide family planning services.
Therefore, Srivastava and colleagues decided to investigate whether the closure of women's health clinics had an effect on cervical cancer rates and mortality. They focused on 100 women's clinics that closed between 2010 and 2013 in the U.S. Among the 50 states, 37 states had clinic closures, while 13 did not.
For the study, the team used data from 200,000 women in the Behavioral Risk Factors Surveillance Study (BRFSS) and more than 10,000 women in the Surveillance, Epidemiology, and End Results (SEER) registry.
The group found the following:
- Women in states that saw clinics close had a 36% higher mortality rate than women in states where clinics didn't close, a rate that rose to 40% among residents in urban areas.
- States that had clinic closures saw a 2% drop in cervical cancer screenings compared with states without clinic closures.
- The greatest screening declines in states with clinic closures were among patients without insurance, Hispanic women, women between the ages of 21 and 34, and single women.
- States that had clinic closures saw a 13% decrease in early-stage diagnosis for women between the ages of 18 and 34 compared with states that did not experience clinic closures.
- There was a trend toward increased late-stage diagnoses for women between the ages of 18 and 34 in states with clinic closures, with 8% more women being diagnosed with late-stage disease.
What's more, the clinic closures appeared to be higher in the Midwest and South, Srivastava said in a press briefing sponsored by ASTRO.
The study results should raise concerns, she concluded.
"We saw that in women living in states with clinic closures, there was a relative reduction in the number of women undergoing screening for cervical cancer," Srivastava said in a press briefing on Monday. "This led to changes in terms of the stage of diagnosis, a reduction in the number of early-stage diagnoses, and a trend toward increases in late-stage diagnoses, which ultimately translated into an increased risk of death."
In a commentary on the study, Dr. Geraldine Jacobson of West Virginia University said the research points out the effect that policy changes can have on the health of some of the most underserved members of the population.
"This study illustrates that ... changes that decrease access to screening have downstream, bad health effects and generally worse health outcomes," Jacobson said. "Policy affects people. If we make changes to policy or legislation, we are impacting people's health and people's lives."
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