title: Influence of health insurance status on inclusion of HER-2/neu testing in the diagnostic workup of breast cancer patients.
abstract: OBJECTIVE
  . To assess the prevalence of HER-2/neu testing in a community-based health care system shortly after the approval of several laboratory kits for HER-2/neu testing for diagnostic purposes by the US Food and Drug Administration and to discern the best discriminating variables for inclusion of the test in the diagnostic workup of breast cancer patients.
  
  
  METHODS
  A retrospective cross-sectional study was designed to analyze data for the period beginning 1 January 1999 and ending 31 December 2000.
  
  
  METHODS
  Henry Ford Health System, the largest health care system in southeastern Michigan, is a comprehensive, self-contained system.
  
  
  METHODS
  Four hundred and fifty-one women diagnosed with primary invasive breast cancers were consecutively sampled from the tumor registry of the Henry Ford Health System.
  
  
  RESULTS
  The proportion of women tested for HER-2/neu increased by 2-fold during year 2 of the observation. Absence of estrogen receptors (OR = 1.96, 95% CI 1.15-3.21), physicians with specialty in surgery (OR = 6.21, 95% CI 2.88-13.33, P = 0.0001), and having a capitated insurance (OR = 1.59, 95% CI 1.06-2.44, P = 0.027) were associated with HER-2/neu testing.
  
  
  CONCLUSIONS
  Absence of estrogen receptors was the only pathological characteristic associated with HER-2/neu testing. The effect of specialization in surgery on the increased likelihood of HER-2/neu testing can be explained mostly by the 'patient volume effect'. The observed disparity in the delivery of innovative diagnostic approaches to cancer patients was influenced by the type of health insurance. Implementation of institutional policies can improve in providing universal quality of care for all patients regardless of their health insurance.
authors.affiliation: Henry Ford Health System, Detroit, MI 48202, USA. astarkI@hfhs.org
authors.forename: Azadeh
authors.initials: A
authors.lastname: Stark
authors.forename: Gena
authors.initials: G
authors.lastname: Kucera
authors.forename: Mei
authors.initials: M
authors.lastname: Lu
authors.forename: Sarah
authors.initials: S
authors.lastname: Claud
authors.forename: Jennifer
authors.initials: J
authors.lastname: Griggs
mesh_terms: D014408:Biomarkers, Tumor; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000235:genetics; D005260:Female; D018734:Genes, erbB-2; D006801:Humans; D019458:Insurance Coverage; D008824:Michigan; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D014408:Biomarkers, Tumor