Certain types of insurance coverage led to deviations from standard breast cancer treatment, according to a study involving nearly 130,000 individuals.

Participants were between 18 and 64 years of age and had surgically-treated nonmetastatic ductal/lobular breast cancers. Investigators looked at links between insurance status and 1) choice of surgical procedure, 2) omission of radiotherapy following breast conserving surgery (BSC), and 3) administration of post-mastectomy radiation. Among the results:

• 85% of patients were insured, 12% had Medicaid, and 2% were uninsured.
• Receiving Medicaid or not being insured was linked with large, node positive tumors; black race; and low income.
• 53% of insured patients had BSC, vs 48% of those who were uninsured and 45% of those on Medicaid.
• In multivariable analysis, Medicaid patients were 7% more likely to receive a mastectomy.
• Uninsured patients were nearly 30% more likely to not receive radiotherapy after BCS; those on Medicaid were 14% more likely to not receive such.