Disparities in access to breast cancer treatment: An observational study based on insurance status.

Abstract

6534 Background: Breast cancer is the second leading cause of cancer death in Caucasians and African-Americans, and the most common cause of cancer death in Hispanic women. Methods: A retrospective analysis was done with data obtained from 1473 hospitals by National cancer database (NCDB) for the years 2004-2014. Patients with breast cancer were analyzed for differences in treatment offered based on their insurance status. Patients in the insurance group were enrolled under either Private, Medicare, Medicaid or other government insurance. Treatments offered were surgery, chemotherapy, radiation therapy or a combination of the above. Patients with unspecified insurance status and those who were on active surveillance were excluded from the analysis. Results: A total of 2,245,259 patients with breast cancer from all age groups were identified from the registry. 47,294 patients did not have insurance; among which 3275 (7.4%) were not offered any treatment. Among 2,093,809 patients with insurance, 58,726 (2.8%) patients were not offered any treatment. Hence, patients without insurance were twice (OR 2.65; CI 2.55-2.75 p < 0.0001) more likely to not receive any first course treatment. Sub-group analysis for different stages of breast cancer showed; carcinoma in-situ (OR 2.44; CI 2.20-2.71 p < 0.0001), stage1 (OR 2.68; CI 2.43-2.96 p < 0.0001), stage2 (OR 2.86; CI 2.61-3.12 p < 0.0001), and stage 3 (OR 2.56; CI 2.25-2.92 p < 0.0001) have similar odds for not being offered any treatment. However, the odds of receiving treatment were better for stage 4 breast cancer (OR 1.44; CI 1.32-1.55 p < 0.0001). Uninsured Caucasians (OR 2.70; CI 2.56-2.85 p < 0.0001) were less likely to receive any treatment compared to uninsured African-Americans (OR 2.16; CI 2.00-2.33 p < 0.0001) and uninsured Hispanics (OR 1.66; CI 1.52-1.82 p < 0.0001) Conclusions: With the recent suggested changes in health care policy, we can expect the number of uninsured patients to rise and therefore more patients might not have access to breast cancer treatment.