New research presented at the Annual Meeting of the American Society for Radiation Oncology (ASTRO) found that the closing of nearly 100 women’s health clinics between 2010 and 2013 across the United States resulted in fewer women being screened for cervical cancer, more diagnoses being made later when the disease was more advanced and greater mortality rates, reports ASTRO.

For the study, researchers grouped states into two cohorts: those that experienced a decrease in the number of women’s health clinics per capita from 2010 to 2013 and those with either no decrease in the number of clinics or an increase in the number of clinics providing reproductive and other health services to women. In addition, they used the data of nearly 200,000 women to evaluate screening utilization and the data of more than 10,000 women to evaluate cancer stage at diagnosis and mortality.

There was a 2% decrease in cervical cancer screenings in states that had clinic closures. The greatest declines in screenings were among those without insurance, Hispanic women, women ages 21 to 34 and unmarried women.

With fewer screenings, diagnoses came later. In states where clinics closed compared with states where they stayed open, for example, 13% fewer women between ages 18 and 34 were diagnosed with early-stage cervical cancer and 8% more were diagnosed with late-stage cervical cancer. The risk of dying of cervical cancer increased greatly, especially in folks living in urban neighborhoods. By contrast, in states that didn’t have clinic closures, survival rates improved.

“In order to see a difference in cancer survival rates, you usually need very mature, long-term follow-up data,” said Amar Srivastava, MD, MPH, a resident physician in radiation oncology at Washington University School of Medicine in St. Louis and lead author on the study. “What is surprising about this study is that even though these closures occurred just a few years ago, we are already seeing clear differences in death versus survival from cervical cancer.”

Cervical cancer is a preventable disease thanks to the human papillomavirus (HPV) vaccine and screening that detects precancerous lesions. The issue now, Srivastava says, is making sure that women have access to screening.

But the closure of women’s health clinics is only likely to get worse after the Trump administration has prohibited Title X grantees from providing or referring patients for abortions, according to the American College of Obstetricians and Gynecologists. (Title X ensures access to a broad range of family planning and preventive health services.)

Clinics such as those of Planned Parenthood, which has withdraw from the federal family planning program because of these restrictions, provide low-income women with birth control and pregnancy test services as well as screenings for sexually transmitted infections and breast and cervical cancer. Without these clinics, many women will be unable to receive the preventive health care service and information they need.