Original Article
Insurance Status Effects on Stage of Diagnosis and Surgical Options Used in the Treatment of Breast Cancer
Abstract
Objectives: Insurance status has the potential to play a significant role in an individual’s health care by affecting the time of diagnosis and the treatment options used. Our study reviewed insurance status as a determinant of the time of a breast cancer diagnosis as well as the surgical treatment options offered.Methods: The American College of Surgeons’ National Cancer Database benchmark reports were used to examine first-course surgery stratified by the stage of breast cancer diagnosed between 2000 and 2010. The data were stratified according to insurance status with a focus on insured patients versus underinsured patients. The relations among insurance status, breast cancer stage at the time of presentation, and initial treatment offered were then evaluated.
Results: There was a statistically significant relation between breast cancer stage at the time of diagnosis and insurance status. There also was a relation between insurance status and the treatment offered. Adequately insured patients presented at an earlier stage than did underinsured patients. In addition, in patients who present with early-stage disease, insured patients had a higher rate of breast-conserving surgery than did underinsured patients, 62.4% and 55.5%, respectively. This trend continued in late-stage breast cancer, in which mastectomy was the predominant treatment option overall. Despite this, insured patients underwent breast-conserving therapy more frequently than did underinsured patients, 24.2% and 21.2%, respectively.
Conclusions: The discrepancy of the stage of diagnosis between insured patients and underinsured patients can be attributed to a host of factors, among which are access to regular office visits and screening tests for breast cancer. In addition, the surgical treatment options used may depend on the cost of treatment and accessibility to and compliance with follow-up care.
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References
1. Centers for Disease Control and Prevention US Cancer Statistics Working Group. United States cancer statistics: 1999-2006 incidence and mortality Web-based report. http://apps.nccd.cdc.gov/uscs. Accessed August 11, 2013.
2. National Cancer Institute. SEER cancer statistics review, 1975-2010. http://seer.cancer.gov/csr/1975_2010. Accessed August 11, 2013.
3. American Cancer Society. Surgery for breast cancer. www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-treating-surgery. Accessed August 11, 2013.
4. Ayalew Ali A, Xiao H, Kiros GE. Health insurance and breast-conserving surgery with radiation treatment. Am J Manag Care 2014;20:502-516.
5. American College of Surgeons. NCDB public benchmark reports. Cases diagnosed 2000-2011. http://cromwell.facs.org/BMarks/BMPub/Ver10/bm_reports.cfm. Accessed April 4, 2013.
6. Lowry R. VassarStats. http://vassarstats.net/index.html. Accessed February 23, 2015.
7. Haji-Jama S, Gorey KM, Luginaah IN, et al. Health insurance mediation of the Mexican American non-Hispanic white disparity on early breast cancer diagnosis. Springerplus 2013;2:285.
8. Farkas DT, Greenbaum A, Singhal V. Effect of insurance status on the stage of breast and colorectal cancers in a safety-net hospital. J Oncol Pract 2012;8(3 suppl):16s-21s.
9. Medicaid and CHIP Payment and Access Commission. Report to the Congress on Medicaid and CHIP. http://healthreformgps.org/wp-content/uploads/MACPAC_March2011_web.pdf. Published March 2011. Accessed August 27, 2013.
10. Kuehn BM. Poverty shift may burden health system. JAMA 2007;297:1047-1048.
11. Hing E, Burt C. Characteristics of Office-Based Physicians and Their Practices: United States, 2003-04. Series 12, No. 164. Hyattsville, MD: National Center for Health Statistics, 2007.
12. Grau JJ, Zanon G, Caso C, et al. Prognosis in women with breast cancer and private extra insurance coverage. Ann Surg Oncol 2013;20:2822-2827.
13. Kerr EA, Siu AL. Follow-up after hospital discharge: does insurance make a difference? J Health Care Poor Underserved 1993;4:133-142.
14. Kelz RR, Gimotty PA, Polsky D, et al. Morbidity and mortality of colorectal carcinoma surgery differs by insurance status. Cancer 2004;101:2187-2194.
15. Bickell NA, Wang JJ, Oluwole S, et al. Missed opportunities: racial disparities in adjuvant breast cancer treatment. J Clin Oncol 2006;24:1357-1362.
16. Yancik R, Wesley MN, Ries LA, et al. Effect of age and comorbidity in postmenopausal breast cancer patients aged 55 years and older. JAMA 2001;285:885-892.
17. Gwyn K, Bondy ML, Cohen DS, et al. Racial differences in diagnosis, treatment, and clinical delays in a population-based study of patients with newly diagnosed breast carcinoma. Cancer 2004;100:1595-1604.
18. Gorin SS, Heck JE, Cheng B, et al. Delays in breast cancer diagnosis and treatment by racial/ethnic group. Arch Intern Med 2006;166:2244-2252.
19. Sariego J. Patterns of breast cancer presentation in the United States: does geography matter? Am Surg 2009;75:545-550.
20. Sariego J. Regional variation in breast cancer treatment throughout the United States. Am J Surg 2008;196:572-574.
