title: Insurance status and the severity of breast cancer at the time of diagnosis.
abstract: OBJECTIVE
  To evaluate how the insurance status of women diagnosed with breast cancer correlates with size and stage at the time of diagnosis.
  
  
  METHODS
  The age-adjusted incidence of early- and late-stage breast cancer as determined by the tumor node metastasis classification system of stages in situ, local, regional, or distant was calculated for insured and uninsured women from our institution's database between 2002 and 2004. Late-stage breast cancer was defined as present when patients had either regional or distant disease. Statistical analysis was conducted using generalized linear models and chi(2) tests.
  
  
  RESULTS
  There were a total of 617 patients in our retrospective study. Of these, 564 (91.4%) had insurance and 53 (8.6%) were uninsured. Four hundred forty-seven (72.4%) patients were Caucasian and 170 (27.6%) patients were non-Caucasian. Of the 463 patients with early-stage breast cancer (0, I, or II), 433 (93.5%) had insurance and 30 (6.5%) were uninsured. Of the 154 patients with late-stage breast cancer (III or IV), 131 (85.1%) had insurance and 23 (14.9%) patients were uninsured. Analysis demonstrated that there was a significant effect in the insurance status on cancer stage (P = .006) and tumor size (P = .010). Compared to insured patients, uninsured patients had a 66% higher likelihood of presenting with a late-stage cancer and larger tumor. The analysis from the chi(2) test also supports the above with a significant association between patients' cancer stage and insurance status (P = .001) and also between tumor size and insurance status (P = .001). Patients' ages and geographic locations were not significant correlated with size and stage, but non-Caucasians had a significantly higher risk of larger tumors and more advanced stage than Caucasians (P < .005).
  
  
  CONCLUSIONS
  Uninsured, non-Caucasian patients have a higher probability of presenting with a more advanced stage of breast cancer and larger tumor size than patients with insurance in a large university multidisciplinary breast cancer population.
authors.affiliation: Department of Radiology, University of North Carolina Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, CB# 5120 Manning Dr., Chapel Hill, NC 27599-7510, USA. cherie_kuzmiak@med.unc.edu
authors.forename: Cherie M
authors.initials: CM
authors.lastname: Kuzmiak
authors.forename: Sinisa
authors.initials: S
authors.lastname: Haberle
authors.forename: Wittaya
authors.initials: W
authors.lastname: Padungchaichote
authors.forename: Donglin
authors.initials: D
authors.lastname: Zeng
authors.forename: Elodia
authors.initials: E
authors.lastname: Cole
authors.forename: Etta D
authors.initials: ED
authors.lastname: Pisano
mesh_terms: D001943:Breast Neoplasms / Q000145:classification* / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D009657:North Carolina / Q000453:epidemiology; D015995:Prevalence; D012720:Severity of Illness Index; D013223:Statistics as Topic