Scientific Session 28 — Breast - Screening/PathologyFriday, May 5, 2017
2481. Uninsured Patients: A Distinct Subpopulation of Patients With Breast Cancer
Morrow D, Lewis M*, White-Gilbertson S, Collins H, Leddy R. Medical University of South Carolina, Charleston, SC
Address correspondence to M. Lewis (firstname.lastname@example.org)
Objective: The purpose of this study is to describe the distribution of insurance status among breast cancer patients at a National Cancer Institute academic medical center, and analyze the relationship of insurance status at diagnosis to screening practice and stage of disease.
Materials and Methods: Deidentified patient data were gathered from two sources, the National Cancer Database Participant User File (NCDB PUF) and our local cancer registry. This study was categorized as nonhuman research by our institutional review board. The NCDB PUF is a flat file containing demographic, stage, biomarker, treatment, and outcome data for a single disease site. This data can only be accessed by members of facilities accredited by the Commission on Cancer. We applied for and were awarded an NCDB PUF file including diagnoses from 2004–2013 for breast cancer. Information on patients newly diagnosed with breast cancer in fiscal year 2015, from July 1, 2014, to June 30, 2015, was obtained from our local cancer registry database for a total of 166 patients. Registry data fields include method of tumor identification, race, derived stage (American Joint Commission on Cancer system), site specific factors (biomarkers), age at diagnosis, and insurance status. Male patients and those with noncanonical breast cancer histology (lymphoma, sarcoma) were excluded. Data were analyzed using chi-square and Fisher exact tests, with comparisons between uninsured patients and those with any type of insurance. Statistical significance was set at 0.05.
Results: We compared a 3-year period prior to implementation of the Affordable Care Act (ACA) (2007–2009) to the first three years after the ACA (2011–2013). Both before and after the ACA, patients without insurance at diagnosis presented with similar distributions of stage. Medicaid patient patterns mirror those of the uninsured. Patients with private insurance, Medicare, or other governmental insurance were similar in terms of their stage at diagnosis. The rate of uninsured patients in our local population was 7.9%, nearly four times the reported rate in the National Cancer Database (2.29% before ACA and 1.99% after ACA). The uninsured cohort was a distinct population, with a distribution of stage that was significantly different from patients with any type of insurance. Compared to insured patients, uninsured patients were younger (age range, 40–64 years) (95.2% vs 55.5%, p < 0.001), more likely to be African American (42.9% vs 19.2%, p = 0.011), less likely to have their disease detected by screening mammography (28.6% vs 60%, p = 0.005), and more likely to present with late stage disease (stage III or IV) (33.3% vs 13.1%, p = 0.027).
Conclusion: Breast cancer patients who are uninsured at diagnosis are more likely to be younger, African American, less likely to have their cancer detected by screening mammography, and more likely to present with late stage disease compared to insured patients. These healthcare disparities should be addressed by policy makers, health care providers, and insurance providers.