This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Alert me to new issues of the journal Download to citation manager Rights & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Kimmick, G. Articles by Anderson, R. Search for Related Content PubMed Articles by Kimmick, G. Articles by Anderson, R.

Racial Differences in Patterns of Care Among Medicaid-Enrolled Patients With Breast Cancer

Duke University Medical Center, Durham; Departments of Medicine, Surgery, and Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC; Ohio State University, Columbus, OH

PURPOSE: Suboptimal care among minority and low-income patients may explain poorer survival. There is little information describing patterns of health care in Medicaid-insured women with breast cancer in the United States. Using a previously created and validated database linking Medicaid claims and state-wide tumor registry data, we describe patterns of breast cancer care within a low-income population.

METHODS: Sample characteristics were described by frequencies and means. Logistic regressions were used to determine predictors of type of surgery, use of radiation therapy after breast-conserving surgery (BCS), and use of adjuvant chemotherapy.

RESULTS: The sample consisted of 974 women. The dataset included only white (58%) and black (42%) women. Sixty-seven percent were treated with mastectomy; 43% received adjuvant chemotherapy; and 67% of women receiving BCS received adjuvant radiation. In multivariate analysis, predictors of BCS were young age, black race, and smaller tumor size. Furthermore, there was a trend toward more black than white women with tumors 4 cm or larger having BCS (18% v 8%; P = .06). Race was not related to use of adjuvant radiation therapy after BCS or to use of adjuvant chemotherapy.

CONCLUSION: In this group of patients with breast cancer enrolled in Medicaid, black women were more likely than white women to have BCS. Race was not associated with adjuvant radiation therapy or chemotherapy use. Factors affecting the quality of care delivered to low-income and minority patients are complex, and better care lies in exploring areas that need improvement.