title: Health insurance and breast-conserving surgery with radiation treatment.
abstract: OBJECTIVE
  To examine the impact of health insurance type on treatment of early-stage breast cancer using breast-conserving surgery (BCS) with radiation therapy (RT) among women in Florida and identify factors that contribute to the variations in receiving the treatment in women with the same health insurance type.
  
  
  METHODS
  Breast cancer cases diagnosed during 1997 to 2002 were obtained from the Florida Cancer Data System. Women 40 years and older diagnosed with localized breast cancer were included. Demographic, insurance, and treatment information were extracted and linked with 2000 census data. χ² and multilevel logistic regression analyses were used.
  
  
  RESULTS
  A total of 33,706 women were diagnosed with localized breast cancer in Florida during 1997 to 2002. The average age of the women was 66 years, 58.62% had BCS while 38.61% had mastectomy, and only 2.77% had no surgical treatment. Type of health insurance plays a significant role in receiving BCS with RT. Furthermore, we found significant variations in the use of BCS with RT among women who have the same type health insurance by marital status, age, tumor size, year of diagnosis, level of education, and poverty level.
  
  
  CONCLUSIONS
  Although clinical practice guidelines recommend BCS with RT to treat women with localized breast cancer, significant differences in receiving the recommended treatment is found between and within types of health insurance. Identifying cultural barriers and educating the public about available treatment options are the major policy implications of this study. These observed differences require further study.
authors.forename: Askal Ayalew
authors.initials: AA
authors.lastname: Ali
authors.forename: Hong
authors.initials: H
authors.lastname: Xiao
authors.affiliation: Institute of Public Health, College of Pharmacy and Pharmaceutical Sciences, Florida Agricultural and Mechanical University, FSH Science Research Center, Rm #209-B, Tallahassee, Florida 32307. E-mail: ge.kiros@famu.edu.
authors.forename: Gebre-Egziabher
authors.initials: GE
authors.lastname: Kiros
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005431:Florida; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D016015:Logistic Models; D008408:Mastectomy / Q000706:statistics & numerical data; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data*; D008875:Middle Aged; D012189:Retrospective Studies; D012959:Socioeconomic Factors