Longitudinal, population-based study of racial/ethnic differences in adequate breast cancer care among women using Medicare Fee-for-Service and Managed Care Organization models

Objective: Racial and ethnic minority women have lower receipt of adequate breast cancer care than White women in the Medicare fee-for-service (FFS) environment, however, greater proportions of Latina and African American women use Medicare Managed Care Organizations (MCO) compared to FFS. This research investigates if ethnic minorities also receive less adequate breast cancer care in the MCO environments. Methods: The linked Surveillance, Epidemiology, and End Results-Medicare database identified 135,434 women diagnosed with early stage breast cancer from 1992–2000. Adequate care breast cancer care was evaluated using a combined measure examining surgery, radiation therapy and documentation of estrogen receptor status. A generalized linear mixed model was used to control for variability in MCO models by state. Results: Although women using FFS were less likely to receive adequate breast cancer care than women using Medicare MCOs, odds ratio 1.22 (1.18-1.27), Latina and African American women were also less likely to receive adequate breast cancer care than white women independent of MCO or FFS Medicare utilization; odds of receipt of adequate breast cancer care in a n MCO environment: 1.16 (1.03,1.30) and 1.14 (0.99,1.30), respectively. Conclusions: Ethnic disparities exist within the MCO environment regarding receipt of adequate breast cancer care. Research using SEER-Medicare FFS only and evaluating Latina ethnicity may underestimate the use of adequate care in Latina breast cancer patients, meaning the receipt of adequate breast cancer care in Latina women may be even lower than previously reported.