Distance to radiation therapy facility influences surgery type among older women with early‐stage breast cancer

Abstract

Background Breast‐conserving surgery plus radiation (BCT) yields equivalent or better survival than mastectomy for early‐stage breast cancer (ESBC) women. However, nationwide mastectomy trends increased in recent decades, attracting studies on underlying causes. Prior research identified that long distance to the radiation treatment facility (RTF) was associated with mastectomy. Still, it is unclear whether such association applies to young and old ESBC women comparably. We sought to delineate such impacts by age. Methods Women diagnosed with stages 0–II breast cancer in 2013–2017 receiving either BCT or mastectomy were identified from the Louisiana Tumor Registry. We assessed the association of surgery (mastectomy vs. BCT) with the distance to the nearest or nearest accessible RTFs using multivariable logistic regression adjusting the socio‐demographic and tumor characteristics. The nearest accessible RTF was determined based on patients' health insurance. For Medicaid, uninsured, and unknown insurance patients, the nearest accessible RTF is the nearest RTF owned by the government. The interaction effect of age and distance was evaluated as well. Results Of 11,604 patients, 46.7% received mastectomy. Compared with distance ≤5 miles to the nearest RTF, those with distance ≥40 miles or 15–40 miles had higher odds of mastectomy (adjusted (adj) OR = 1.39, 95% CI = 1.07–1.82; adj OR = 1.17, 95% CI = 1.02–1.34). To the nearest accessible RTF, the adj ORs were 1.25 (95% CI = 1.03–1.51) and 1.19 (95% CI = 1.04–1.35), respectively. Age‐stratified analysis showed the significant association ( p < 0.05) only presented among women aged ≥65, but not those aged <65 years. Conclusion Distance to the nearest or nearest accessible RTF influences the surgery choice, especially among women in Louisiana ≥65 years with ESBC. Further understanding of factors leading to the decision for mastectomy in this age group is needed.

Factors associated with diagnostic and pre‐treatment intervals among breast cancer patients attending care at the Uganda Cancer Institute: A cross‐sectional study

“…Similar findings of U‐shaped associations in regards to distance from treatment facility, and cancer stage as well as 5‐year mortality have been reported before, especially for colorectal and oral cancers 44–49 . Regarding distance from cancer treatment facilities and mode of treatment, breast cancer patients in the USA living within 5 miles had lower odds of mastectomy compared to those living ≥40 miles 50 . It is not completely understood why patients from near cancer‐specialized treatment facilities get diagnosed after longer time or choose a different modality of treatment compared with those living far.…”

“…[44][45][46][47][48][49] Regarding distance from cancer treatment facilities and mode of treatment, breast cancer patients in the USA living within 5 miles had lower odds of mastectomy compared to those living ≥40 miles. 50 It is not completely understood why patients from near cancer-specialized treatment facilities diagnosed after longer time or choose a different modality of treatment compared with those living far. The people living so very close may know the deficiencies of their health system and or the challenges associated with receiving care at the facilities and would perhaps only go there as last resort, while those far away may have limited knowledge of the services and would endeavor to reach as soon as they can.…”