Effect of insurance payer status on the surgical treatment of early stage breast cancer: data analysis from a single health system.

Area of Science:

• Oncology
• Health Services Research
• Surgical Oncology

Background:

• Insurance payer status is a known social determinant of health.
• Understanding its impact on surgical treatment for early-stage breast cancer is crucial for equitable care.

Purpose of the Study:

• To investigate the association between insurance payer status and mastectomy rates in early-stage breast cancer patients.
• To compare treatment patterns between women with Medicaid and those with private insurance.

Main Methods:

• Retrospective cohort study of 1539 women treated within a single health system.
• Analysis of tumor size and mastectomy rates based on insurance payer status (Medicaid vs. private insurance).

Main Results:

• Women with Medicaid presented with significantly larger tumors (3.3 cm vs. 2.1 cm) compared to those with private insurance (PI).
• Medicaid patients were more likely to undergo mastectomy for larger tumors.
• Paradoxically, women with PI were more likely to have mastectomy for smaller tumors (47% vs. 11% for tumors < 2 cm).
• Overall, women with Medicaid had higher mastectomy rates (60% vs. 39%) compared to those with PI.

Conclusions:

• Insurance payer status is associated with differences in surgical treatment for early-stage breast cancer.
• Disparities exist in tumor size at diagnosis and treatment decisions, including mastectomy rates, based on insurance.
• Further research is needed to address these disparities and ensure equitable breast cancer care.