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The effect of insurance payer status on surgical treatment of early stage breast cancer is unclear. This retrospective study examined the effect of insurance payer on mastectomy rates of 1539 women treated within a single health system. Women with Medicaid had significantly larger tumors compared with those with private insurance (PI) at diagnosis (3.3 cm vs 2.1 cm, P < .05) and were more likely to be treated with mastectomy for larger tumors compared with women with PI. However, women with PI were more likely to have mastectomy for smaller tumors; among women with tumors less than 2 cm, 11% with Medicaid underwent mastectomy compared with 47% with PI (P < .05). Overall, when compared with those with PI, women with Medicaid were more likely to receive mastectomy (60% vs 39%, P < .05).

BACKGROUNDThe purpose of the study was to determine the risk of ipsilateral breast carcinoma recurrence (IBCR) and contralateral breast carcinoma (CBC) development in patients with a concurrent diagnosis of ductal carcinoma in situ (DCIS) with atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), or lobular carcinoma in situ (LCIS).METHODSRecords of all 307 patients with DCIS treated with breast‐conserving treatment (BCT) from 1968 to 1998 were analyzed. Initial pathology reports and all slides available were re‐reviewed for evidence of ADH, ALH, or LCIS. Actuarial local recurrence rates were calculated.RESULTSFifty‐five cases of DCIS were associated with ADH, 11 with ALH or LCIS, and 14 with both ADH and ALH or LCIS. Overall, IBCR occurred in 14% and no significant difference in the IBCR rate was identified for patients with proliferative lesions compared with patients without these lesions (P = 0.38). Development of CBC in patients with concurrent DCIS and ADH was 4.4 times (95% confidence interval [CI], 1.44–13.63) that in patients with DCIS alone (P < 0.01). The 15‐year cumulative rate of CBC development was 22.7% in patients with ALH or LCIS compared with 6.5% in patients without these lesions (P = 0.30) and 19% in patients with ADH compared with 4.1% in patients with DCIS alone (P < 0.01).CONCLUSIONThe risk of CBC development is higher with concurrent ADH than in patients with DCIS alone, and these patients may therefore be appropriate candidates for additional chemoprevention strategies. Concurrent ADH, ALH, or LCIS with DCIS is not a contraindication to BCT. Cancer 2006. © 2005 American Cancer Society.

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