Insurance Status Predicts Survival in Women with Breast Cancer: Results of Breast and Cervical Cancer Treatment Program in California

BACKGROUND AND PURPOSE: The Breast and Cervical Cancer Treatment Program (BCCTP) Act, passed by Congress in 2000, provides time-limited coverage to uninsured breast or cervical cancer patients. We examine survival differences between BCCTP cases and insured controls. METHODS: Stage I-III breast cancer patients, covered under California’s BCCTP from 2005–2009 (N=6,343), were 1:1 matched with California Cancer Registry (CCR) controls on age, race/ethnicity, and cancer stage. Overall and disease-specific (OS and DSS) survival were compared using multivariate regression. RESULTS: BCCTP cases were more often unmarried (Odds Ratio [OR]=2.47, 95% Confidence Interval [CI]=2.30–2.66), with poorly/undifferentiated tumors (OR=1.26, CI=1.13–1.40), classified as ER negative (OR=1.10, CI=1.02–1.20) and/or PR negative (OR=1.09, CI=1.01–1.17). Cases were more likely to undergo mastectomy (OR=1.13, CI=1.05–1.21) or no surgery (OR=1.64, CI=1.31–2.05) versus lumpectomy. Cases were also more likely to undergo radiation (OR=1.11, CI=1.03–1.19). Endocrine therapy rates were marginally lower in cases (OR=0.93, CI=0.86–1.00). OS and DSS were shorter in BCCTP cases on multivariate analysis (HR=1.29, CI=1.17–1.42 and HR=1.27, CI=1.14–1.42, respectively). When stratified by socioeconomic status (SES), cases had significantly shorter OS and DSS except in the lowest quintile. When stratified by stage, cases had significantly shorter OS and DSS, except for stage I. CONCLUSIONS: The BCCTP provides uninsured breast cancer patients with comprehensive and timely care. Although our results suggest that BCCTP delivers quality care, BCCTP patients have shorter survival rates, even after accounting for SES and stage differences. Further assistance to vulnerable populations is warranted, including longer duration of treatment coverage, and surveillance adhering to NCCN compliant surveillance programs.