6592 Background: Given barriers to access, uninsured women with breast cancer might experience delays in diagnosis and treatment when compared to insured women. The influence of insurance status on breast cancer outcome was addressed at a single institution whose mission statement requires that all pts be treated the same, regardless of their ability to pay Methods: Records of all pts with breast cancer seen from 1/00- 12/04 at a safety net hospital were reviewed. Insurance status was defined at the time of the first abnormal mammogram. Cases were divided into Group A (private insurance), B (medicaid or medicare) or C (uninsured). Time to diagnosis (TDx) was defined as the interval from abnormal mammogram to pathologic diagnosis of breast cancer. Time to treatment (TRx) was defined as time from pathologic diagnosis to definitive surgical therapy. Results: 560 cases were reviewed. Group A: 48%, B: 33%, C: 19%. Median age= 57 (GrpA=53, B= 67, C= 55). Race Caucasian 59%; AA 34%; other 7%. Stage (0, I, II, III and IV, in %, respectively): Grp A= 14.6, 42.9, 31.5, 7.1 and 3.9; Grp B= 13.1, 46, 22.7, 12.5 and 5.7; Grp C = 13.9, 33.7, 32.7, 11.9 and 7.9. No significant diff between groups, although there was a trend towards later (III/IV) pts in grps B and C than A (18.2% and 19.8% vs 10.9%, respectively). Mean TDx: Grp A= 50.6 days, B= 68.1d and C=52.8d; p= 0.006 when Group B was compared to the other two groups but there was no difference between uninsured and private groups. Mean TRx: 43.8d, 48.6d and 47.8 days, respectively, for groups A, B and C, without any statistical difference between any of the groups. Conclusions: A 5-year review of breast cancer cases at a large safety net hospital did not reveal any difference in the time to diagnosis or initiation of treatment for insured vs. uninsured pts. Uninsured and medicaid/medicare pts tended to present with later stage disease, perhaps due to access problems. A statistically significant delay in diagnosis was noted in the medicaid/medicare group but it is unlikely that this difference (18 days) was clinically important. Because uninsured pts are provided care at greatly discounted rates at our institution, these results may differ from those at other institutions. Further studies addressing this issue are warranted. No significant financial relationships to disclose.
Delays in Diagnosis and Treatment of Breast Cancer: A Safety-Net Population Profile
