title: Factors which affect use of breast conservation and mastectomy in an underinsured Hispanic population.
abstract: BACKGROUND
  Despite no difference in overall survival between breast conservation and mastectomy, significant variation exists between institutions and within populations. Less data exists about racial and ethnic minority populations. The current study was performed to evaluate variables that affect use of breast conservation and mastectomy in an underinsured Hispanic population.
  
  
  METHODS
  A retrospective review was performed of all patients who self-identified as of Hispanic ethnicity and underwent breast cancer operations from July 2001 to February 2011 at a safety net hospital. Sociodemographic, clinical, and treatment variables were evaluated. All patients with documented contraindications to breast conservation were excluded. Univariate analysis and multivariate analysis were performed to identify variables which were associated with type of operation.
  
  
  RESULTS
  The average age of the 219 patients included was 50 years. Most of the patients (93%) were insured with Medicaid or uninsured and 59% presented with clinical stage 2A/B cancers. Mastectomy was performed in 33% of patients and 67% had breast conservation. In adjusted multivariate analysis higher pathologic stage (p=0.01) and English speakers (p=0.03) were associated with mastectomy. By contrast, higher BMI (p=0.03) and use of preoperative chemotherapy (p=0.01) were associated with breast conservation.
  
  
  CONCLUSIONS
  In this underinsured Hispanic population, patients with higher pathologic stage and English speaking patients were more likely to undergo mastectomy. Patients who underwent preoperative chemotherapy and who had higher BMI were more likely to undergo breast conservation.
authors.affiliation: Maricopa Medical Center, Phoenix, AZ, 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: Moores University of California San Diego Cancer Center, San Diego, CA, USA.
authors.forename: Jesse N
authors.initials: JN
authors.lastname: Nodora
authors.affiliation: Maricopa Medical Center, Phoenix, AZ, USA.
authors.forename: Marcia E
authors.initials: ME
authors.lastname: Bouton
authors.affiliation: Maricopa Medical Center, Phoenix, AZ, USA.
authors.forename: Justin
authors.initials: J
authors.lastname: Nalagan
authors.affiliation: Moores University of California San Diego Cancer Center, San Diego, CA, USA.
authors.forename: Maria Elena
authors.initials: ME
authors.lastname: Martinez
authors.affiliation: Maricopa Medical Center, Phoenix, AZ, 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; D001130:Arizona; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D007802:Language; D008327:Mammography / Q000706:statistics & numerical data; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data*; D008484:Medicaid; D017057:Medically Uninsured; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D059351:Organ Sparing Treatments / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States
keywords: Breast conservation; Ethnicity; Hispanic; Latina; Lumpectomy; Preoperative chemotherapy