Background: In 2012, new diagnoses of cervical cancer in the United States are estimated to affect 12 170 women, and 4220 women will die from the disease. Despite the fact that cervical cancer is easily detected and testing is inexpensive, approximately 50 percent of those diagnosed will present with late stage disease at the time of diagnosis. Women who are uninsured or Medicaid-insured have an increased risk of being diagnosed with late stage cervical cancer. The purpose of this systematic review is to examine the relationship between the timing of Medicaid enrollment and the stage of cervical cancer at the time of diagnosis to better identify populations at increased risk.
Method: An exhaustive search of the literature was conducted in Medline (Ovid), CINAHL, and Web of Science using the following search terms: Medicaid, neoplasm, cervical cancer and uterine cervical neoplasms. Studies that compared Medicaid-insured patients and non-Medicaid-insured patients, along with the stage of cervical cancer at the time of diagnosis were included.
Results: A total of 32 studies were screened, and four studies met the eligibility criteria for this systematic review. One study was defined as a cross-sectional study. Three studies were retrospective cohorts. All studiesincluded in this review demonstrated an increased risk of late stage cervical cancer at the time of diagnosis that was dependent upon the timing of Medicaid enrollment. Enrollment prior to diagnosis was associated with less risk overall. Women enrolling in Medicaid at the time of diagnosis were three times more likely to present with late stage disease, and those enrolling after diagnosis had a five-fold increase in risk.
Conclusion: The results from this systematic review demonstrate a trend of increased risk of late stage cervical cancer for women whose enrollment in Medicaid is close to, on, or after diagnosis. Continuous and/or prolonged enrollment prior to diagnosis was associated with less risk overall, and may be analogous to non-Medicaid insured women. The increased risk for women who enroll in Medicaid after diagnosis underscores the need to increase outreach to underserved women who do not qualify for Medicaid until they have been diagnosed with cervical cancer or precancerous lesions.
Keywords: Medicaid, cervical cancer, cancer stage at diagnosis
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