Factors which affect the use of lumpectomy and mastectomy in an underinsured, safety net hospital population

Background This study was performed to evaluate variables that affect the use of mastectomy and lumpectomy in an underinsured population. Methods A retrospective review of all patients who underwent breast cancer operations from July 2001 to February 2011 at a safety net hospital was performed. Univariate and multivariate analyses were performed to identify variables, which were associated with the type of operation. Results Of the 412 patients, 81% of the patients were underinsured or uninsured. Most patients (58%) presented with clinical stage 2A/B disease. Mastectomy was performed in 37% of patients and lumpectomy in 63%. In multivariate analysis, clinical tumor size (P =.035) and pathologic stage (P =.003) remained associated with mastectomy, while use of preoperative chemotherapy (P =.004) and type of surgeon (P =.001) was associated with lumpectomy. Conclusions Most patients underwent lumpectomy despite later stage at presentation. Preoperative chemotherapy was associated with increased likelihood of lumpectomy.