Travel Distance and Season of Diagnosis Affect Treatment Choices for Women with Early-stage Breast Cancer in A Predominantly Rural Population (United States)
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Current standards of care for early-stage breast cancer include either breast-conserving surgery (BCS) with post-operative radiation or mastectomy. A variety of factors influence the type of treatment chosen. In northern, rural areas, daily travel for radiation can be difficult in winter. We investigated whether proximity to a radiation treatment facility (RTF) and season of diagnosis affected treatment choice for New Hampshire women with early-stage breast cancer.
Using a population-based cancer registry, we identified all women residents of New Hampshire diagnosed with stage I or II breast cancer during 1998–2000. We assessed factors influencing treatment choices using multivariate logistic regression.
New Hampshire women with early-stage breast cancer were less likely to choose BCS if they live further from a RTF (P < 0.001). Of those electing BCS, radiation was less likely to be used by women living >20 miles from a RTF (P = 0.002) and those whose diagnosis was made during winter (P = 0.031).
Our findings indicate that a substantial fraction of women with early-stage breast cancer in New Hampshire receive suboptimal treatment by forgoing radiation because of the difficulty traveling for radiation in winter. Future treatment planning strategies should consider these barriers to care in cold rural regions.
KeywordsBreast cancer Breast-conserving surgery Geographic factors Radiotherapy Season
We thank Dr. Dale Collins (Dartmouth Hitchcock Medical Center), Dr. John Seavey and Dr. Greta Bauer (University of New Hampshire) for their helpful review and discussion of the manuscript, and Andrew Chalsma (New Hampshire Department of Health and Human Services) for his continuous support of this project. This work was supported by the New Hampshire Department of Health and Human Services, Department of Community and Family Health (Contract No. 710374) and the Norris Cotton Cancer Center Core Grant (P30 CA23108).
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