A 23-year old federal program for the early detection and treatment of cervical cancer markedly reduces illness and death among underserved, low-income women, yet its impact has been reduced by the fact that it has reached only 10 percent of the eligible population, finds a new study in the American Journal of Preventive Medicine.
To reduce disparities in cervical cancer incidence and mortality, the U.S. Congress passed the Breast and Cervical Cancer Mortality Prevention Act in 1990, explain the researchers. The law authorized the establishment of the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), which was enacted in 1991. Since then, more than 2.9 million women have been screened for cervical cancer and 3,206 invasive cancers have been detected.
Lead author Donatus Ekwueme, Ph.D., explained that the research used a simulation model to measure three things: (1) the number of life-years the program saved; (2) the quality of those years; and (3) the number of deaths averted. "We compared the 1.8 million women who were screened by the NBCCEDP between 1991 and 2007 to two other groups of women—women who received screening by a different program and women who didn't receive any screening," he said. When the researchers compared the impact of the NBCCEDP program versus other screening programs, they found that the federal program resulted in 325 lives, or 10,369 life years, saved. Comparing NBCCEDP participants to women not screened at all, 3,829 lives were saved, adding up to 101,509 life years. The NBCCEDP has also improved the health-related quality of life of the participants.
In addition to these direct benefits, noted Ekwueme, "it's important to understand that the NBCCEDP program confers many indirect benefits. It has helped uninsured women gain access to the health care system, improving their health in other areas." For example, many NBCCEDP participants also receive care through the WISEWOMAN (for Well-Integrated Screening and Evaluation for Women Across the Nation) program that provides screening for heart disease and stroke risk.
Ronald Gray, M.D., professor of population, family and reproductive health at the Johns Hopkins Bloomberg School of Public Health, observes that finding that the screening program reduces mortality and improves survival is important but not surprising since the impact of Pap screening is well documented.
Gray points out that "the study doesn't consider newer more sensitive and specific screening methods such as HPV screening and thus doesn't reflect the 'state of the art.'" He also notes the unfortunate low rate of program participation during the years that the study covers. With only 10 percent of eligible women receiving services, 90 percent went unscreened for easily detected cervical cancers.
The researchers do foresee the NBCCEDP reaching more eligible women in the future, as poor women gain better insurance coverage under the Affordable Care Act. The authors wrote, "In the U.S., access to cancer screening is highly dependent on access to affordable, acceptable medical care." By increasing insurance coverage rates for NBCCEDP-eligible women, those women will enjoy improved access to preventive care.
More information: "Impact of the National Breast and Cervical Cancer Early Detection Program on Cervical Cancer Mortality Among Uninsured Low-Income Women in the U.S.," 1991–2007. Ekwueme, Donatus U. et al., American Journal of Preventive Medicine dx.doi.org/10.1016/j.amepre.2014.05.016