Abstract
Objectives
Assess the effect of race/ethnicity and insurance coverage on the receipt of standard treatment for local breast cancer.
Methods
Local breast cancers diagnosed between July 1997 and December 2000 and reported to Florida’s registry were linked to the Agency of Healthcare Administration inpatient and outpatient databases, resulting in 23,817 female local breast cancers with informative treatment. Standard treatment was defined as mastectomy or breast-conserving surgery followed by radiation therapy and it was modeled as a function of health insurance and race/ethnicity accounting for age at diagnosis, marital status and facility type.
Results
Approximately 88% of the local breast cancers received standard treatment. The likelihood of standard treatment decreased by 3% per year of increase in the age at diagnosis. Compared to white non-Hispanic, black non-Hispanic women were 19% less likely to receive standard treatment (OR=0.81, 95%CI=0.68, 0.97) and Hispanics were 23% less likely (OR=0.77, 95%CI=0.66, 0.89). Local breast cancers diagnosed in non-teaching facilities were 21% more likely to receive standard treatment compared to those diagnosed in teaching facilities (OR=1.21; 95%CI=1.05, 1.38)). Compared to single, married women were 51% more likely to get standard treatment (OR=1.51, 95%CI=1.31, 1.66), followed by separated or divorced women that were 37% more likely (OR=1.37, 95%CI =1.13, 1.66). Compared to the privately insured, Medicare beneficiaries were 36% more likely to receive standard treatment (OR=1.36, 95%CI=1.22, 1.51) whereas the uninsured were 24% less likely (OR=0.76, 95%CI=0.59, 0.96); Medicaid insured women were 29% less likely to receive standard treatment compared to the uninsured (OR=0.71, 95%CI=0.53, 0.96).
Conclusion
Future efforts should target the elderly, Hispanic and black women, the uninsured, and those on Medicaid in order to reduce treatment disparities.
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Acknowledgement
This study was partly funded by Grant #FS-02 from the American Cancer Society, Florida Division. The authors would like to thank the Florida abstractors for collecting the data and enabling studies such as this one and the Florida Cancer Data System and the Florida Department of Health for their support. Additionally we would like to thank the Minnesota Cancer Registry for providing the X-walk54 software, for the conversion of CPT codes to SEER treatment codes, and the Agency of Health Care Administration for allowing us to use their data for this study.
Human Participant Protection: The study protocol was approved by the University of Miami and the University of Florida IRBs and by the Florida Department of Health.
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Voti, L., Richardson, L.C., Reis, I. et al. The effect of race/ethnicity and insurance in the administration of standard therapy for local breast cancer in Florida. Breast Cancer Res Treat 95, 89–95 (2006). https://doi.org/10.1007/s10549-005-9050-6
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DOI: https://doi.org/10.1007/s10549-005-9050-6