Rationale and Objectives
To evaluate how the insurance status of women diagnosed with breast cancer correlates with size and stage at the time of diagnosis.
Methods and Materials
The age-adjusted incidence of early- and late-stage breast cancer as determined by the tumor node metastasis classification system of stages in situ, local, regional, or distant was calculated for insured and uninsured women from our institution’s database between 2002 and 2004. Late-stage breast cancer was defined as present when patients had either regional or distant disease. Statistical analysis was conducted using generalized linear models and χ 2 tests.
Results
There were a total of 617 patients in our retrospective study. Of these, 564 (91.4%) had insurance and 53 (8.6%) were uninsured. Four hundred forty-seven (72.4%) patients were Caucasian and 170 (27.6%) patients were non-Caucasian. Of the 463 patients with early-stage breast cancer (0, I, or II), 433 (93.5%) had insurance and 30 (6.5%) were uninsured. Of the 154 patients with late-stage breast cancer (III or IV), 131 (85.1%) had insurance and 23 (14.9%) patients were uninsured. Analysis demonstrated that there was a significant effect in the insurance status on cancer stage ( P = .006) and tumor size ( P = .010). Compared to insured patients, uninsured patients had a 66% higher likelihood of presenting with a late-stage cancer and larger tumor. The analysis from the χ 2 test also supports the above with a significant association between patients’ cancer stage and insurance status ( P = .001) and also between tumor size and insurance status ( P = .001). Patients’ ages and geographic locations were not significant correlated with size and stage, but non-Caucasians had a significantly higher risk of larger tumors and more advanced stage than Caucasians ( P < .005).
Conclusions
Uninsured, non-Caucasian patients have a higher probability of presenting with a more advanced stage of breast cancer and larger tumor size than patients with insurance in a large university multidisciplinary breast cancer population.
Health care is a subject of substantial concern in the United States. More than 45 million Americans lack health insurance and many more are underinsured ( ). Studies have shown that individuals without health insurance are less likely to receive cancer screening and other preventive services because of cost and access to health care ( ).
Recent studies have demonstrated that there is a link between insurance coverage and health outcomes ( ). Because insurance coverage is associated with differences in outcome, it is most evident for diseases that can be diagnosed and treated early ( ). Such an example is breast cancer. Breast cancer may take years to develop and often there are no symptoms of the disease in the early stages.
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Materials and methods
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Results
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Table 1
Characteristics of Insurance Type
Insurance Type Number of Patients Percent Managed Care 344 55.75 Medicare 66 10.70 Medicare with supplement 55 8.91 Medicaid 49 7.94 Private insurance 37 6.00 Military 13 2.11 Not insured 53 8.59
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Table 2
Distribution of the Breast Cancer Tumor Sizes Among Insured Patients versus Uninsured Patients
Insurance Status Tumor T1 Tumor T2 Tumor T3 Insured patients: 564 (91.4%) 406 (71.9%) 147 (26.1%) 11 (2%) Uninsured patients: 53 (8.6%) 21 (39.6%) 10 (18.9%) 22 (41.5%)
Table 3
Distribution of the Cancer Stages Among Insured Patients versus Uninsured Patients
Insurance Status Cancer Stages 0, I, II Cancer Stages III, IV Insured patients: 564 (91.4%) 433 (76.8%) 131 (23.2%) Uninsured patients: 53 (8.6%) 30 (56.6%) 23 (43.3%)
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Discussion
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