Insurance, location, income drive breast cancer surgery choices

Key clinical point: Insurance status, income, and travel distance to treatment facilities are associated with the likelihood of having breast-conserving surgery.

Major finding: Women with no health insurance were 25% less likely than those with private insurance to receive breast-conserving surgery.

Data source: Analysis of data from 727,927 women in the National Cancer Data Base.

Disclosures: The researchers declared no conflicts of interest.

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Barriers exist to breast cancer treatment

Optimal breast-conserving surgery for most lumpectomy-eligible patients requires a commitment to whole-breast radiation, which also requires access to a radiation oncologist and specialized treatment facility. This is an often insurmountable barrier for patients who lack transportation, have job or family responsibilities, or who live a considerable distance from a radiation facility.

Dr. Lisa A. Newman

Socioeconomically disadvantaged patients are typically the ones who face these obstacles, and these burdens of financial deprivation are disproportionately faced by minority racial/ethnic groups and rural communities.

Tragically, disadvantage will continue to breed more disadvantage.

Dr. Lisa A. Newman is director of the Breast Care Center at the University of Michigan Comprehensive Cancer Care Center, Ann Arbor, Mich. These comments are taken from an accompanying editorial (JAMA Surgery 2015 June 17 [doi:10.1001/jamasurg.2015.1114]). Dr. Newman declared no conflicts of interest.




The rates of breast-conserving surgery have increased over the last 2 decades among women with early-stage breast cancers in the United States, but disparities persist, based on an analysis of data from the National Cancer Data Base.

The rate of breast-conserving surgery has risen from approximately 54% in 1998 to 60% in 2011, but this rate may have been affected by “technical advances and changes in societal norms [that] include genetic testing for BRCA1 and BRCA2 mutation, advances in reconstruction techniques, breast magnetic resonance imaging, and increased patient interest in contralateral prophylactic mastectomy,” Dr. Meeghan Lautner and her colleagues at University of Texas MD Anderson Cancer Care Center, Houston, wrote.

“Among the most encouraging findings from our analysis is the considerable improvement of disparities based on facility type and the options afforded to older populations … however, insurance, income, and travel distance to treatment facilities persist as key barriers to [breast-conserving therapy] use,” the researchers said.

Their analysis of a cohort of 727,927 women, published online June 17 in JAMA Surgery, showed that women with early breast cancer were less likely to receive breast-conserving surgery if they had a low educational level, public or no health insurance, and low income.

Women aged 52-61 years were 14% more likely to be treated with breast-conserving surgery, compared with younger women. White race, fewer comorbidities, and living closer to a treatment facility were all positively associated with being treated with breast-conserving surgery.

Those in southern regions of the United States were significantly less likely to receive breast-conserving surgery, compared with those in the Northeast. The researchers said their data suggest the lower rates are because of the greater travel distances to treatment facilities in the South.

Women with no insurance were 25% less likely than those with private insurance to have breast-conserving therapy (JAMA Surgery 2015 June 17 [doi:10.1001/jamasurg.2015.1102]).

The researchers declared no conflicts of interest.

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