title: Factors which affect the use of lumpectomy and mastectomy in an underinsured, safety net hospital population.
abstract: BACKGROUND
  This study was performed to evaluate variables that affect the use of mastectomy and lumpectomy in an underinsured population.
  
  
  METHODS
  A retrospective review of all patients who underwent breast cancer operations from July 2001 to February 2011 at a safety net hospital was performed. Univariate and multivariate analyses were performed to identify variables, which were associated with the type of operation.
  
  
  RESULTS
  Of the 412 patients, 81% of the patients were underinsured or uninsured. Most patients (58%) presented with clinical stage 2A/B disease. Mastectomy was performed in 37% of patients and lumpectomy in 63%. In multivariate analysis, clinical tumor size (P = .035) and pathologic stage (P = .003) remained associated with mastectomy, while use of preoperative chemotherapy (P = .004) and type of surgeon (P = .001) was associated with lumpectomy.
  
  
  CONCLUSIONS
  Most patients underwent lumpectomy despite later stage at presentation. Preoperative chemotherapy was associated with increased likelihood of lumpectomy.
authors.affiliation: Maricopa Medical Center, Hogan Building, 2nd Floor, 2601 E Roosevelt Street, Phoenix, AZ 85008, USA.
authors.forename: Anne E
authors.initials: AE
authors.lastname: Klemens
authors.affiliation: Maricopa Medical Center, Hogan Building, 2nd Floor, 2601 E Roosevelt Street, Phoenix, AZ 85008, USA.
authors.forename: Lyndsay
authors.initials: L
authors.lastname: Olsen-Deeter
authors.affiliation: Arizona Cancer Center, University of Arizona, Tucson, AZ, USA; Mel and Enid Zuckerman Arizona College of Public Health, University of Arizona, Tucson, AZ, USA.
authors.forename: Chiu-Hsieh
authors.initials: CH
authors.lastname: Hsu
authors.affiliation: Maricopa Medical Center, Hogan Building, 2nd Floor, 2601 E Roosevelt Street, Phoenix, AZ 85008, USA.
authors.forename: Marcia E
authors.initials: ME
authors.lastname: Bouton
authors.affiliation: Maricopa Medical Center, Hogan Building, 2nd Floor, 2601 E Roosevelt Street, Phoenix, AZ 85008, USA.
authors.forename: Brano
authors.initials: B
authors.lastname: Djenic
authors.affiliation: Maricopa Medical Center, Hogan Building, 2nd Floor, 2601 E Roosevelt Street, Phoenix, AZ 85008, USA.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Winton
authors.affiliation: Maricopa Medical Center, Hogan Building, 2nd Floor, 2601 E Roosevelt Street, Phoenix, AZ 85008, USA; Arizona Cancer Center, University of Arizona, Tucson, AZ, USA. Electronic address: Komenaka@hotmail.com.
authors.forename: Ian K
authors.initials: IK
authors.lastname: Komenaka
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D001130:Arizona; D001943:Breast Neoplasms / Q000191:economics / Q000208:ethnology / Q000601:surgery*; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D016015:Logistic Models; D008408:Mastectomy / Q000191:economics / Q000706:statistics & numerical data; D015412:Mastectomy, Segmental / Q000191:economics / Q000706:statistics & numerical data*; D017057:Medically Uninsured; D008875:Middle Aged; D008913:Minority Groups; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D064876:Safety-net Providers; D044465:White People
keywords: Breast conservation; Ethnicity; Lumpectomy; Minority; Preoperative chemotherapy; Race