{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T12:43:54Z","timestamp":1771332234240,"version":"3.50.1"},"reference-count":53,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2023,5,29]],"date-time":"2023-05-29T00:00:00Z","timestamp":1685318400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Reports"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Over a decade of evidence supports the claim that increased access to insurance through Medicaid expansions improves early detection of cancer. Yet, evidence linking Medicaid expansions to early detection of head and neck cancers (HNC) of the oral cavity and pharynx, specifically, may be limited by the lack of attention to Human Papillomavirus (HPV) etiology, generosity of dental coverage, and valid inference analyzing state cancer registry data.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>This study\u00a0reexamined the effect of Medicaid expansion on early detection of HPV+\/\u2212 HNC in states offering extensive dental benefits.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>Specialized data from the Surveillance, Epidemiology, and End Results (SEER) program was analyzed to account for, previously unmeasurable, differential detection patterns of HNCs associated with HPV. Then, to identify the effect of increasing Medicaid eligibility on staging patterns in states offering extensive benefits amidst potentially non\u2010common trends between states, a \u201cTriple Differences\u201d design identifies the differential effect of Medicaid Expansion (with dental coverage) on HPV\u2010negative HNCs relative to the change in HPV\u2010positive HNCs. For valid inference analyzing a small number of state clusters (12) in cancer registry data, each regression model applies a Wild Cluster Bootstrap.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Expanding Medicaid eligibility was found to be associated with a decrease in the proportion of distant\u2010stage diagnoses of HPV(\u2212) HNCs, but only among states which increased Medicaid dental generosity at the time of Medicaid expansion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>These results suggest that adding extensive Medicaid dental benefits was the primary mechanism impacting HNC detection. This study highlights the potential positive spillover effects of policies which increase access to public dental coverage for low\u2010income adults, while also showing the limitation of access to dental services for improving early detection of HPV+ HNCs.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cnr2.1840","type":"journal-article","created":{"date-parts":[[2023,5,30]],"date-time":"2023-05-30T06:15:20Z","timestamp":1685427320000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Examining the effect of Medicaid expansion on early detection of head and neck cancer of the oral cavity and pharynx by <scp>HPV<\/scp>\u2010type and generosity of dental benefits"],"prefix":"10.1002","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0375-8090","authenticated-orcid":false,"given":"Jason","family":"Semprini","sequence":"first","affiliation":[{"name":"Department of Health Management and Policy University of Iowa College of Public Health  Iowa City Iowa USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,5,29]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2017.1491"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djaa043"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.30314"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjoto.2020.102464"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2018.1792"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.canep.2020.101763"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41415\u2010022\u20105166\u2010x"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41572\u2010020\u201000224\u20103"},{"key":"e_1_2_12_10_1","volume-title":"Cancer of the Oral Cavity and Pharynx \u2013 Cancer Stat Facts","author":"NCI","year":"2022"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/1758\u20103284\u20104\u201015"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djab192"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2019.4310"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2020.104870"},{"issue":"9","key":"e_1_2_12_15_1","first-page":"1047","article-title":"Screening for the early detection and prevention of oral cancer","volume":"83","author":"Lin K","year":"2011","journal-title":"Am Fam Physician"},{"key":"e_1_2_12_16_1","volume-title":"Screening for Oral Cancer: A Targeted Evidence Update for the U.S. Preventive Services Task Force","author":"Olson CM","year":"2013"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.14219\/jada.archive.2010.0223"},{"issue":"7","key":"e_1_2_12_18_1","first-page":"1379","article-title":"Assessing oral malignancies","volume":"65","author":"Weinberg MA","year":"2002","journal-title":"Am Fam Physician"},{"key":"e_1_2_12_19_1","unstructured":"SempriniJ.Specialized HNC\u2010HPV cancer registry data and two\u2010way fixed effects decomposition: re\u2010examining Medicaid expansion's effect on early detection of oral cancer. 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