Differences in treatment for patients with LCIS based on insurance status.
Authors: Greidinger Alison , Ahmed Sharif , Michael Ashley , Yoon-Flannery Kahyun , Hunter Krystal , Robles-Rodríguez Evelyn , Abou Hussein Ahmed K. 
Published: June 2022

e18510 Background: It is well established that insurance coverage is strongly related to better health outcomes, however there has been little research comparing health care disparity between public vs privatehealth insurance. The aim of our research is to identify differences in treatment in patients with lobular carcinoma in situ (LCIS) based on insurance payer seen at our academic center in Southern New Jersey. Additional analysis included time from diagnosis to treatment and common reasons treatment was not obtained. Our goal is to provide further information on health care disparities between insurance payers and identify areas for improvement. Methods: We conducted a retrospective chart review of 292 patients with LCIS who were seen at the MD Anderson Cancer Center at Cooper in Camden, Voorhees and Willingboro, New Jersey from 2009 to 2019. We stratified the patient population by insurance payer; specifically Medicare, Medicaid and private insurance. We compared treatment outcomes between these three groups using chi square and Kruskall Wallis testing. Results: There was no significant difference in treatment outcome or time to treatment between insurance payers. The majority of patients in each insurance payer group did receive appropriate treatment with either chemoprevention or prophylactic mastectomy. Among those patients who did not receive risk reduction therapy, 22.2% of patients with Medicaid did not see a Medical Oncologist and therefore were not offered chemoprevention. In comparison, only 16.7% of patients with private insurers did not see a Medical Oncologist. Although not statistically significant, this supports prior studies suggesting a disparity in outpatient follow up for patients with Medicaid. Patients with Medicaid had the longest median time from diagnosis to initiation of chemoprevention as compared to patients with Medicare or private insurance. It was notable that among patients who underwent prophylactic bilateral mastectomy, those with Medicaid had the shortest observed time to surgery than patients with private insurance. The reasoning for more expedited times to prophylactic mastectomy than to chemoprevention in our study is unclear. Possible factors include patient perception of bilateral mastectomy being a “definitive” one time procedure eliminating the need for future screening and anxiety related to suspicious findings. Other causes may include the concern for adverse side effects of chemoprevention or patient decision to pursue surgery prior to Medical Oncology follow up. Conclusions: There was no significant difference in treatment outcomes for patients with LCIS based on insurance payer. This is a reassuring finding that provides evidence of appropriate care regardless of insurance payer. In the future, we hope to stratify this data by race and zip code to further assess health care disparities in our patient population in order to provide improvement in their care.