Closure of Women’s Health Clinics Resulting in Increased Cases of Cervical Cancer

Between 2010 and 2013, nearly 100 U.S. women’s health clinics closed due to state restrictions placed on reproductive services. Because of this, researchers have observed adverse effects on women’s health, including decreased screening, increased stage at presentation, and higher mortality from cervical cancer, according to data presented at the 2019 ASTRO Annual Meeting and published in the International Journal of Radiation Oncology.

Researchers used data from the Behavioral Risk Factors Surveillance Study (BRFSS) to evaluate screening utilization. They also obtained information on stage at diagnosis and mortality via the Surveillance, Epidemiology, and End Results (SEER) 18 Registry.

States were categorized as those that decreased the number of women’s health clinics providing abortion per capita and those that did not between 2010 and 2013. They specifically analyzed women included in BRFSS and SEER in 2008 to 2009 and compared outcomes with women in 2014 to 2015. The final cohort included 197,143 cases from BRFSS and 10,652 from SEER.

At baseline, there were observed differences between the states that did and did not close these facilities that were related to race/ethnicity, metropolitan residence, county income and education, and insurance status in both the BRFSS and SEER cohorts during both time periods studied.

Decline is screenings and early-stage diagnoses in states that closed more clinics

The researchers observed a 2% decrease in screening in states that decreased the number of clinics compared with those that did not (P=0.01). Subgroups that were most affected included:

• Hispanic women (P=0.01)
• Women aged 21-34 years (P<0.01)
• Unmarried women (P<0.003)
• Uninsured patients (P=0.01)

While cervical cancer survival rates improved in states that did not close clinics, there was a 36% increase in mortality risk due to cervical cancer in states that closed clinics.

There was a decline in early-stage diagnoses among women aged 18 to 34 years in states that closed facilities (95% CI, -25.17 to -1.23; P=0.031). There was also a significant increase in the hazard ratio (HR) of death in states that closed facilities both overall (HR=1.36; 95% CI, 1.02-1.83; P=0.037) and among metropolitan residents (HR=1.40; 95% CI, 1.04-1.9; P=0.027).

“Though causality cannot be confirmed, these findings warrant further evaluation, particularly in the context of ongoing legal battles related to these laws,” the researchers concluded.