Michelle Davis1, Kyle Strickland2, Sarah Rae Easter3, Michael Worley4, Colleen Feltmate4, Michael Muto4, Neil Horowitz4, Ross Berkowitz4, Sarah Feldman4. 1. Division of Gynecologic Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States. Electronic address: mdavis31@bwh.harvard.edu. 2. Division of Women's and Perinatal Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Division of Gynecologic and Obstetric Pathology, Department of Pathology, Duke University Medical Center, Durham, NC, United States. 3. Division of Maternal Fetal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States. 4. Division of Gynecologic Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
Abstract
OBJECTIVE: To evaluate the impact of insurance status on the stage of cervical cancer diagnosed and treated at a tertiary care center in Massachusetts and review the preceding screening history. METHODS: An IRB approved retrospective cohort study was conducted of patients with a diagnosis of cervical cancer treated at Brigham and Women's Hospital (BWH) between January 2011 and June 2016. Clinical and demographic data was extracted from the longitudinal medical record. Statistical analysis was performed using SAS. RESULTS: 117 cases of cervical cancer met the inclusion criteria during the study period. Most patients (76%) were diagnosed with stage I disease. On univariate analysis, compared to patients with private insurance, patients with public insurance or no documented insurance presented at older ages, were more likely to be non-white races, and present with advanced stage disease. In an adjusted model, the risk of being diagnosed with advanced stage disease persisted among women with public or no documented insurance, adjusted odds ratio (aOR) 4.13 (1.37-12.45). There was no difference in screening history among women with private vs. public insurance, p = 0.30. CONCLUSIONS: Despite access to insurance, patients with public issued insurance had an increased risk of presenting with advanced stage cervical cancer in this cohort. These data suggest that additional barriers to screening and prevention may exist and are important for future investigation.
OBJECTIVE: To evaluate the impact of insurance status on the stage of cervical cancer diagnosed and treated at a tertiary care center in Massachusetts and review the preceding screening history. METHODS: An IRB approved retrospective cohort study was conducted of patients with a diagnosis of cervical cancer treated at Brigham and Women's Hospital (BWH) between January 2011 and June 2016. Clinical and demographic data was extracted from the longitudinal medical record. Statistical analysis was performed using SAS. RESULTS: 117 cases of cervical cancer met the inclusion criteria during the study period. Most patients (76%) were diagnosed with stage I disease. On univariate analysis, compared to patients with private insurance, patients with public insurance or no documented insurance presented at older ages, were more likely to be non-white races, and present with advanced stage disease. In an adjusted model, the risk of being diagnosed with advanced stage disease persisted among women with public or no documented insurance, adjusted odds ratio (aOR) 4.13 (1.37-12.45). There was no difference in screening history among women with private vs. public insurance, p = 0.30. CONCLUSIONS: Despite access to insurance, patients with public issued insurance had an increased risk of presenting with advanced stage cervical cancer in this cohort. These data suggest that additional barriers to screening and prevention may exist and are important for future investigation.
Authors: Emmanuel N S Sackey; Manideepthi Pemmaraju; Marie R Griffin; Jessica L Castilho Journal: BMC Womens Health Date: 2022-03-12 Impact factor: 2.809