title: Comparing Breast Cancer Outcomes Between Medicaid and the Ohio Breast and Cervical Cancer Early Detection Program.
abstract: OBJECTIVE
  To compare outcomes between women enrolling in Medicaid after being diagnosed with breast cancer and those referred to Medicaid through the Ohio Breast and Cervical Cancer Early Detection Program (BCCEDP).
  
  
  METHODS
  Using linked data from the 2002 to 2008 Ohio Cancer Incidence Surveillance System, Medicaid, the BCCEDP database, and Ohio death certificates (through 2010), we identified women 40 to 64 years of age diagnosed with incident invasive breast cancer during the study years and enrolled in Medicaid 3 months before or after cancer diagnosis. We compared the following outcomes across BCCEDP one-time and repeat participants and nonparticipants: (1) cancer stage at diagnosis, (2) treatment delays, (3) receipt of standard treatment, and (4) survival. We conducted multivariable logistic regression and survival analysis to examine the association between BCCEDP participation and the outcomes of interest, controlling for potential confounders.
  
  
  RESULTS
  We identified 427 and 654 BCCEDP participants and nonparticipants, respectively; 28.5% of BCCEDP women were repeat participants. Compared with nonparticipants, BCCEDP one-time and repeat participants were significantly less likely to be diagnosed with advanced-stage cancer (one-time: adjusted odds ratio [AOR], 0.64; 95% CI, 0.49 to 0.85; repeat: AOR, 0.34; 95% CI, 0.23 to 0.52), or experience delays in treatment initiation (one-time: adjusted hazard ratio [AHR], 1.29; 95% CI, 1.09 to 1.51; repeat: AHR, 1.38; 95% CI, 1.11 to 1.72). In addition, although we observed no difference in receipt of standard cancer treatment, BCCEDP participants experienced cancer-specific and overall survival benefits.
  
  
  CONCLUSIONS
  Compared with nonparticipants, BCCEDP participants experienced earlier breast cancer stage at diagnosis, shorter time to treatment initiation, and survival benefits.
authors.affiliation: Case Western Reserve University; Case Comprehensive Cancer Center, Case Western Reserve University; University Hospitals of Cleveland; and Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Cleveland, OH skoroukian@case.edu.
authors.forename: Siran M
authors.initials: SM
authors.lastname: Koroukian
authors.affiliation: Case Western Reserve University; Case Comprehensive Cancer Center, Case Western Reserve University; University Hospitals of Cleveland; and Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Cleveland, OH.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Bakaki
authors.affiliation: Case Western Reserve University; Case Comprehensive Cancer Center, Case Western Reserve University; University Hospitals of Cleveland; and Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Cleveland, OH.
authors.forename: Mark
authors.initials: M
authors.lastname: Schluchter
authors.affiliation: Case Western Reserve University; Case Comprehensive Cancer Center, Case Western Reserve University; University Hospitals of Cleveland; and Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Cleveland, OH.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Owusu
authors.affiliation: Case Western Reserve University; Case Comprehensive Cancer Center, Case Western Reserve University; University Hospitals of Cleveland; and Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Cleveland, OH.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Cooper
authors.affiliation: Case Western Reserve University; Case Comprehensive Cancer Center, Case Western Reserve University; University Hospitals of Cleveland; and Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Cleveland, OH.
authors.forename: Susan A
authors.initials: SA
authors.lastname: Flocke
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D016208:Databases, Factual; D055088:Early Detection of Cancer; D062665:Epidemiological Monitoring; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008484:Medicaid / Q000706:statistics & numerical data*; D008875:Middle Aged; D009367:Neoplasm Staging; D016017:Odds Ratio; D009820:Ohio; D015397:Program Evaluation; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014481:United States