title: Private insurance is the strongest predictor of women receiving breast conservation surgery for breast cancer.
abstract: BACKGROUND
  It is widely accepted that mastectomy and breast-conserving surgery (BCS) with irradiation yield similar results, yet many women continue to receive mastectomy. This study evaluates factors contributing to surgical decision-making in breast cancer. Registry data were obtained on all patients treated at the Southwest Cancer Treatment and Research Center (SWCTRC) between 2002 and 2006. Patient demographics, including age and race, and insurance type, tumor characteristics, surgical procedure performed, lymph node status, stage, adjuvant therapy, and outcome were analyzed against mastectomy versus BCS using bivariate and multivariate analysis.
  
  
  RESULTS
  There was a higher proportion of uninsured patients in the mastectomy cohort, which also included more patients with later stage disease, larger tumor size, and a higher number of lymph node metastases. The only independent predictors of BCS were fewer lymph node metastases and having insurance. Patients with private insurance were almost 4 times more likely to receive BCS (odds ratio 3.90, 95% confidence interval 1.20-12.67).
  
  
  CONCLUSIONS
  Insurance status is an important predictor determining whether a patient receives BCS or mastectomy for breast cancer.
authors.affiliation: Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
authors.forename: Amber
authors.initials: A
authors.lastname: Moreland
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhang
authors.forename: Sharmila
authors.initials: S
authors.lastname: Dissanaike
authors.forename: Rishi
authors.initials: R
authors.lastname: Arya
mesh_terms: D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008408:Mastectomy / Q000379:methods / Q000706:statistics & numerical data*; D008875:Middle Aged; D017149:Private Sector