OBJECTIVES

: Studies report poor outcomes for breast cancer patients with no health insurance or Medicaid coverage. It is not clear if there is an association between insurance status and cancer outcomes for rare cancers like phyllodes tumor (PT). The purpose of the study was to examine the relationship of health insurance status with tumor size at presentation and initial surgical treatments in patients diagnosed with PT.

METHODS

: We conducted a retrospective, cohort study using the Surveillance, Epidemiology and End Results Program (SEER) database for women with PT aged 18-64 and diagnosed between 2007-2014. The exposure of interest was insurance status (non-Medicaid, Medicaid and no insurance). The two outcomes were tumor size at presentation (<5 cm vs >/=5cm) and initial surgical treatment (breast conserving surgery vs. mastectomy). Descriptive statistics were used to describe the relationship between insurance status and all variables of interest. Multivariable logistic regressions were performed to examine the relationship of health insurance status with tumor size at diagnosis and initial surgical treatment.

RESULTS

: A total of 637 women were identified, of which 46% were ages 50-64, 58% were married, and 51% were White. Patients with Medicaid insurance status (OR: 3.81; 95% CI: 2.50-5.83) and no insurance status (OR: 4.02; 95% CI: 1.92-8.45) were more likely to present with tumor size >/=5 cm than patients with non-Medicaid insurance status. Insurance status was not significantly related with initial surgical treatment. Patients with tumor size >/= 5cm (OR: 5.62: 95% CI: 3.90-8.10) and/or not married (OR: 1.52; 95% CI:1.06-2.19) were more likely to have a mastectomy.

CONCLUSIONS

: In our sample, malignant PT patients with Medicaid or no insurance status presented with larger tumor size as an indication of more advanced stage of disease. Our finding suggests adequate health insurance is important for timely intervention for optimal outcomes.