However, women with private insurance were more likely to undergo mastectomy for small tumors.

Disparity in breast cancer treatment among certain patient subgroups is well known. But little has been documented regarding surgical management based on patient financial status. Now, investigators have conducted a retrospective study in a single healthcare system in the Midwest to examine the effect of insurance payer type on mastectomy rates in 1539 women with stage I–III breast cancer.

Women on Medicaid were more likely than those with private insurance to undergo mastectomy (60% vs. 39%; P<0.05) and to have larger tumors at diagnosis (3.3 cm vs. 2.1 cm; P<0.05). Increasing tumor size and stage were independent predictors of mastectomy (P<0 05). Of note, women with private insurance were more likely than those with Medicaid to have mastectomy for smaller (<2 cm) tumors (47% vs.11%; P<0.05).

Comment: Larger tumor size in patients with Medicaid in this study suggests that these women were less likely to receive screening mammography. One important consideration in patients with large primary breast cancer is the use of preoperative systemic therapy to downsize tumors and increase the likelihood of breast-conserving surgery. However, in this healthcare system, the extent of preoperative systemic therapy and its use according to insurance payer are unclear. The finding that women with small breast cancers who had private health insurance were significantly more likely than those with Medicaid to undergo mastectomy is a bit surprising since anecdotal experience in many centers across the U.S. has suggested that an increasing number of women, regardless of insurance status, have been requesting mastectomy and immediate breast reconstruction for small cancers. Therefore, it would be of interest to see what time trends reveal about this issue. Also worth considering is whether treatment of women with Medicaid versus other payers differs by surgeon in this healthcare system. Establishment of system-wide cancer diagnostic and treatment pathways for multidisciplinary practice might also minimize differences in care based on type of insurance.

Source:Journal Watch Oncology and Hematology