title: Insurance status effects on stage of diagnosis and surgical options used in the treatment of breast cancer.
abstract: OBJECTIVE
  Insurance status has the potential to play a significant role in an individual's health care by affecting the time of diagnosis and the treatment options used. Our study reviewed insurance status as a determinant of the time of a breast cancer diagnosis as well as the surgical treatment options offered.
  
  
  METHODS
  The American College of Surgeons' National Cancer Database benchmark reports were used to examine first-course surgery stratified by the stage of breast cancer diagnosed between 2000 and 2010. The data were stratified according to insurance status with a focus on insured patients versus underinsured patients. The relations among insurance status, breast cancer stage at the time of presentation, and initial treatment offered were then evaluated.
  
  
  RESULTS
  There was a statistically significant relation between breast cancer stage at the time of diagnosis and insurance status. There also was a relation between insurance status and the treatment offered. Adequately insured patients presented at an earlier stage than did underinsured patients. In addition, in patients who present with early-stage disease, insured patients had a higher rate of breast-conserving surgery than did underinsured patients, 62.4% and 55.5%, respectively. This trend continued in late-stage breast cancer, in which mastectomy was the predominant treatment option overall. Despite this, insured patients underwent breast-conserving therapy more frequently than did underinsured patients, 24.2% and 21.2%, respectively.
  
  
  CONCLUSIONS
  The discrepancy of the stage of diagnosis between insured patients and underinsured patients can be attributed to a host of factors, among which are access to regular office visits and screening tests for breast cancer. In addition, the surgical treatment options used may depend on the cost of treatment and accessibility to and compliance with follow-up care.
authors.affiliation: From the Department of Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Robert
authors.initials: R
authors.lastname: Lukavsky
authors.affiliation: From the Department of Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Jack
authors.initials: J
authors.lastname: Sariego
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D057210:Delayed Diagnosis; D055088:Early Detection of Cancer; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D007348:Insurance, Health; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data*; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D009367:Neoplasm Staging