title: Breast cancer treatment experiences by race and location in Georgia's Women's Health Medicaid Program.
abstract: BACKGROUND
  This study seeks to understand the breast cancer treatment patterns and experiences of women enrolled in Georgia's Breast and Cervical Cancer Prevention and Treatment Act program, the Women's Health Medicaid Program (WHMP), and whether these experiences vary by race or location.
  
  
  METHODS
  We conducted a mixed-methods analysis of WHMP breast cancer enrollees by race and urban/rural location. Quantitative analysis used a hazard rate model approach to identify differences in the timing of diagnosis, enrollment into Medicaid, and various modalities of treatment for 810 enrollees. Qualitative analysis used a systematic retrieval and review of coded data from 34 in-depth disease life history interview transcripts to a complete, focused analysis of enrollees' cancer treatment experiences.
  
  
  RESULTS
  African-American women began treatment, on average, 6 days later after diagnosis than White women, driven by delays of one month among African-American women with late-stage cancers. This time delay for African-American women was not significant on multivariate analysis of time from enrollment to treatment. Once enrolled in WHMP, women reported gaining access to equitable breast cancer treatment regardless of race or location, with the exception of breast reconstruction, for which some women in our sample reported barriers to care.
  
  
  CONCLUSIONS
  The equitable access to cancer treatment and other health services provided by WHMP to low-income, uninsured women in Georgia with breast cancer makes it a critical health care safety net program in Georgia, the need for which will continue through the implementation of the Affordable Care Act.
authors.affiliation: Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia. Electronic address: emily.johnston@emory.edu.
authors.forename: Emily M
authors.initials: EM
authors.lastname: Johnston
authors.affiliation: Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Blake
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Andes
authors.affiliation: School of Health Care Administration, College of Public Health and Nutrition, Taipei Medical University, Taipei City, Taiwan.
authors.forename: Li-Nien
authors.initials: LN
authors.lastname: Chien
authors.affiliation: Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: E Kathleen
authors.initials: EK
authors.lastname: Adams
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D001943:Breast Neoplasms / Q000191:economics / Q000208:ethnology* / Q000628:therapy*; D005260:Female; D005845:Georgia; D019538:Health Care Surveys; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D007407:Interviews as Topic; D008484:Medicaid / Q000191:economics / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D010549:Personal Satisfaction; D010817:Physician-Patient Relations; D036301:Qualitative Research; D012044:Regression Analysis; D012424:Rural Population / Q000706:statistics & numerical data; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D014481:United States; D014505:Urban Population / Q000706:statistics & numerical data; D044465:White People