title: Factors associated with surgical management in an underinsured, safety net population.
abstract: BACKGROUND
  Few studies include significant numbers of racial and ethnic minority patients. The current study was performed to examine factors that affect breast cancer operations in an underinsured population.
  
  
  METHODS
  We performed a retrospective review of all breast cancer patients from January 2010 to May 2012. Patients with American Joint Committee on Cancer clinical stage 0-IIIA breast cancer underwent evaluation for type of operation: breast conservation, mastectomy alone, and reconstruction after mastectomy.
  
  
  RESULTS
  The population included 403 patients with mean age 53 years. Twelve of the 50 patients (24%) diagnosed at stage IIIB presented with synchronous metastatic disease. Of the remaining patients, only 2 presented with metastatic disease (0.6%). The initial operation was 65% breast conservation, 26% mastectomy alone, and 10% reconstruction after mastectomy. Multivariate analysis revealed that Hispanic ethnicity (odds ratio [OR], 0.38; 95% CI, 0.19-0.73; P = .004), presentation with palpable mass (OR, 0.34; 95% CI, 0.13-0.90; P = .03), preoperative chemotherapy (OR, 0.25; 95% CI, 0.10-0.62; P = .003) were associated with a lesser likelihood of mastectomy. Multivariate analysis of factors associated with reconstruction after mastectomy showed that operation with Breast surgical oncologist (OR, 18.4; 95% CI, 2.18-155.14; P < .001) and adequate health literacy (OR, 3.13; 95% CI, 0.95-10.30; P = .06) were associated with reconstruction.
  
  
  CONCLUSIONS
  The majority of safety net patients can undergo breast conservation despite delayed presentation and poor use of screening mammography. Preoperative chemotherapy increased the likelihood of breast conservation. Routine systemic workup in patients with operable breast cancer is not indicated.
authors.affiliation: Maricopa Medical Center, Phoenix, AZ.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Winton
authors.affiliation: Moores UCSD Cancer Center, San Diego, CA.
authors.forename: Jesse N
authors.initials: JN
authors.lastname: Nodora
authors.affiliation: Moores UCSD Cancer Center, San Diego, CA.
authors.forename: Maria Elena
authors.initials: ME
authors.lastname: Martinez
authors.affiliation: Arizona Cancer Center, University of Arizona, Tucson, AZ; Mel and Enid Zuckerman Arizona College of Public Health, University of Arizona, Tucson, AZ.
authors.forename: Chiu-Hsieh
authors.initials: CH
authors.lastname: Hsu
authors.affiliation: Maricopa Medical Center, Phoenix, AZ.
authors.forename: Brano
authors.initials: B
authors.lastname: Djenic
authors.affiliation: Maricopa Medical Center, Phoenix, AZ.
authors.forename: Marcia E
authors.initials: ME
authors.lastname: Bouton
authors.affiliation: Rady Children's Hospital San Diego, San Diego, CA.
authors.forename: Paula
authors.initials: P
authors.lastname: Aristizabal
authors.affiliation: Maricopa Medical Center, Phoenix, AZ.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Ferguson
authors.affiliation: Department of Family and Community Medicine, University of Arizona, Tucson, AZ.
authors.forename: Barry D
authors.initials: BD
authors.lastname: Weiss
authors.affiliation: Maricopa Medical Center, Phoenix, AZ; Arizona Cancer Center, University of Arizona, Tucson, AZ. Electronic address: Komenaka@hotmail.com.
authors.forename: Ian K
authors.initials: IK
authors.lastname: Komenaka
mesh_terms: D000328:Adult; D000368:Aged; D001130:Arizona; D001943:Breast Neoplasms / Q000175:diagnosis / Q000191:economics / Q000208:ethnology / Q000601:surgery*; D055088:Early Detection of Cancer; D005006:Ethnicity; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology* / Q000706:statistics & numerical data; D006801:Humans; D016462:Mammaplasty / Q000191:economics / Q000706:statistics & numerical data; D008408:Mastectomy / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data*; D017057:Medically Uninsured; D008875:Middle Aged; D008913:Minority Groups; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D016017:Odds Ratio; D012189:Retrospective Studies; D064876:Safety-net Providers / Q000191:economics / Q000208:ethnology / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors