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Breast Cancer Presentation, Surgical Management and Mortality Across the Rural–Urban Continuum in the National Cancer Database

  • Health Services Research and Global Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Objective

The purpose of this study was to examine differences in presentation, surgical management, and mortality among breast cancer patients in the National Cancer Database (NCDB) based on area of residence.

Methods

The NCDB was queried for women with a diagnosis of breast cancer from 1 January 2004–31 December 2015. The data were divided by metropolitan (large, medium, small) and non-metropolitan (urban, rural) status.

Results

Cancer stage increased with rurality (p < 0.0001). Residency in a large metropolitan area was associated with increased breast reconstruction rates (odds ratio [OR] 1.25, 95% confidence interval [CI] 1.19–1.30) and reduced overall mortality (hazard ratio 0.92, 95% CI 0.89–0.95) compared with rural areas. There was no difference in mastectomy use among small metropolitan (OR 1.03, 95% CI 1.01–1.04), urban (OR 0.99, 95% CI 0.98–1), and rural areas (OR 1.05, 95% CI 1.01–1.07) compared with large metropolitan areas.

Conclusions

Across the rural–urban continuum in the NCDB, stage of cancer presentation increased with rurality. Conversely, residency in a large metropolitan area was associated with higher reconstruction rates and a reduction in overall mortality. Future studies should evaluate factors contributing to advanced disease presentation and lower reconstruction rates among rural breast cancer patients.

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References

  1. Newman LA. Breast Cancer Disparities: Socioeconomic Factors versus Biology. Ann Surg Oncol. 2017;24(10):2869–2875.

    Article  Google Scholar 

  2. Singh GK, Williams SD, Siahpush M, Mulhollen A. Socioeconomic, rural-urban, and racial inequalities in US Cancer Mortality: Part I-all cancers and lung cancer and part II-Colorectal, prostate, breast, and cervical cancers. J Cancer Epidemiol. 2011;2011:107497.

    Article  Google Scholar 

  3. Blair SL, Sadler GR, Bristol R, Summers C, Tahar Z, Saltzstein SL. Early cancer detection among rural and urban Californians. BMC Public Health. 2006;6:194.

    Article  Google Scholar 

  4. Williams F, Jeanetta S, James AS. Geographical location and stage of breast cancer diagnosis: a systematic review of the literature. J Health Care Poor Underserved. 2016;27(3):1357–1383.

    Article  Google Scholar 

  5. Celaya MO, Berke EM, Onega TL, et al. Breast cancer stage at diagnosis and geographic access to mammography screening (New Hampshire, 1998-2004). Rural Remote Health. 2010;10(2):1361.

    PubMed  PubMed Central  Google Scholar 

  6. Elliott TE, Elliott BA, Renier CM, Haller IV. Rural-urban differences in cancer care: results from the Lake Superior Rural Cancer Care Project. Minn Med. 2004;87(9):44–50.

    PubMed  Google Scholar 

  7. Mitchell KJ, Fritschi L, Reid A, et al. Rural-urban differences in the presentation, management and survival of breast cancer in Western Australia. Breast. 2006;15(6):769–776.

    Article  CAS  Google Scholar 

  8. American College of Surgeons. National Cancer Database. https://www.facs.org/quality-programs/cancer/ncdb. Accessed 25 Feb 2019.

  9. American College of Surgeons. National Cancer Database: Data Dictionary PUF 2016. http://ncdbpuf.facs.org/node/386. Accessed 16 Feb 2019.

  10. Tseng WH, Stevenson TR, Canter RJ, et al. Sacramento area breast cancer epidemiology study: use of postmastectomy breast reconstruction along the rural-to-urban continuum. Plast Reconstr Surg. 2010;126(6):1815–1824.

    Article  CAS  Google Scholar 

  11. Kruper L, Holt A, Xu XX, et al. Disparities in Reconstruction Rates After Mastectomy: Patterns of Care and Factors Associated with the Use of Breast Reconstruction in Southern California. Ann Surg Oncol. 2011;18(8):2158–2165.

    Article  Google Scholar 

  12. Jacobs LK, Kelley KA, Rosson GD, Detrani ME, Chang DC. Disparities in Urban and Rural Mastectomy Populations. Ann Surg Oncol. 2008;15(10):2644.

    Article  Google Scholar 

  13. Sisco M, Du H, Warner JP, Howard MA, Winchester DP, Yao K. Have we expanded the equitable delivery of postmastectomy breast reconstruction in the new millennium? Evidence from the national cancer data base. J Am Coll Surg. 2012;215(5):658–66 (discussion 666).

  14. Boscoe FP, Johnson CJ, Henry KA, et al. Geographic proximity to treatment for early stage breast cancer and likelihood of mastectomy. Breast. 2011;20(4):324–328.

    Article  Google Scholar 

  15. Dookeran KA, Silva A, Warnecke RB, Rauscher GH. Race/ethnicity and disparities in mastectomy practice in the Breast Cancer Care in Chicago study. Annals of surgical oncology. 2015;22(1):66–74.

    Article  Google Scholar 

  16. Dragun AE, Huang B, Tucker TC, Spanos WJ. Increasing mastectomy rates among all age groups for early stage breast cancer: a 10-year study of surgical choice. Breast J. 2012;18(4):318–325.

    Article  Google Scholar 

  17. Ernster VL, Barclay J, Kerlikowske K, Wilkie H, Ballard-Barbash R. Mortality among women with ductal carcinoma in situ of the breast in the population-based surveillance, epidemiology and end results program. Arch Intern Med. 2000;160(7):953–958.

    Article  CAS  Google Scholar 

  18. Schairer C, Mink PJ, Carroll L, Devesa SS. Probabilities of death from breast cancer and other causes among female breast cancer patients. J Natl Cancer Inst. 2004;96(17):1311–1321.

    Article  Google Scholar 

  19. Cuzick J, Stewart H, Rutqvist L, et al. Cause-specific mortality in long-term survivors of breast cancer who participated in trials of radiotherapy. J Clin Oncol. 1994;12(3):447–453.

    Article  CAS  Google Scholar 

  20. Early Breast Cancer Trialists’ Collaborative Group. Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet. 365(9472):1687–1717.

    Article  CAS  Google Scholar 

  21. Ayanian JZ, Kohler BA, Abe T, Epstein AM. The relation between health insurance coverage and clinical outcomes among women with breast cancer. N Engl J Med. 1993;329(5):326–331.

    Article  CAS  Google Scholar 

  22. Shi R, Taylor H, McLarty J, Liu L, Mills G, Burton G. Effects of payer status on breast cancer survival: a retrospective study. BMC cancer. 2015;15:211.

    Article  Google Scholar 

  23. Hwang ES, Lichtensztajn DY, Gomez SL, Fowble B, Clarke CA. Survival after lumpectomy and mastectomy for early stage invasive breast cancer. Cancer. 2013;119(7):1402–1411.

    Article  Google Scholar 

  24. Slamon D, Eiermann W, Robert N, et al. Adjuvant trastuzumab in HER2-positive breast cancer. N Engl J Med. 2011;365(14):1273–1283.

    Article  CAS  Google Scholar 

  25. Nguyen-Pham S, Leung J, McLaughlin D. Disparities in breast cancer stage at diagnosis in urban and rural adult women: a systematic review and meta-analysis. Ann Epidemiol. 2014;24(3):228–235.

    Article  Google Scholar 

  26. Arcury TA, Preisser JS, Gesler WM, Powers JM. Access to transportation and health care utilization in a rural region. J Rural Health. 2005;21(1):31–38.

    Article  Google Scholar 

  27. Meden T, St John-Larkin C, Hermes D, Sommerschield S. MSJAMA. Relationship between travel distance and utilization of breast cancer treatment in rural northern Michigan. JAMA. 2002;287(1):111.

  28. McCullough LE, Flowers CR. Identifying and addressing disparities in survival outcomes for rural patients with cancer. JAMA Netw Open. 2018;1(4):e181243.

    Article  Google Scholar 

  29. Nattinger AB, Gottlieb MS, Veum J, Yahnke D, Goodwin JS. Geographic variation in the use of breast-conserving treatment for breast cancer. N Engl J Med. 1992;326(17):1102–1107.

    Article  CAS  Google Scholar 

  30. Buckley EJ, Zahnd WE, Rea DJ, Mellinger JD, Ganai S. Impact of rural-urban status on survival after mastectomy without reconstruction versus mastectomy with reconstruction. Am J Surg. 2017;214(4):645–650.

    Article  Google Scholar 

  31. Chiu AS, Thomas P, Killelea BK, Horowitz N, Chagpar AB, Lannin DR. Regional variation in breast cancer surgery: results from the National Cancer Database (NCDB). Am J Surg. 2017;214(5):907–913.

    Article  Google Scholar 

  32. Robertson R, Campbell NC, Smith S, et al. Factors influencing time from presentation to treatment of colorectal and breast cancer in urban and rural areas. Br J Cancer. 2004;90(8):1479–1485.

    Article  CAS  Google Scholar 

  33. Bleicher RJ, Ruth K, Sigurdson ER, et al. Time to Surgery and Breast Cancer Survival in the United States. JAMA Oncol. 2016;2(3):330–339.

    Article  Google Scholar 

  34. Gu J, Groot G, Boden C, Busch A, Holtslander L, Lim H. Review of factors influencing women’s choice of mastectomy versus breast conserving therapy in early stage breast cancer: a systematic review. Clin Breast Cancer. 2018;18(4):e539–e554.

    Article  Google Scholar 

  35. American College of Surgeons. CoC Standards 4.4 and 4.5 Implementation for Surveys in 2015. https://www.facs.org/publications/newsletters/coc-source/special-source/standard4445. Accessed 7 Jan 2020.

  36. Roughton MC, DiEgidio P, Zhou L, Stitzenberg K, Meyer AM. Distance to a plastic surgeon and type of insurance plan are independently predictive of postmastectomy breast reconstruction. Plast Reconstr Surg. 2016;138(2):203e–211e.

    Article  CAS  Google Scholar 

  37. DeCoster RC, Bautista R-MF Jr, Burns JC, et al. Rural-urban differences in breast reconstruction utilization following oncologic resection. J Rural Health. https://doi.org/10.1111/jrh.12396

  38. Unger JM, Moseley A, Symington B, Chavez-MacGregor M, Ramsey SD, Hershman DL. Geographic distribution and survival outcomes for rural cancer patients treated in clinical trials. J Clin Oncol. 2018;36(15 Suppl):6569.

    Article  Google Scholar 

  39. Henley SJ, Anderson RN, Thomas CC, Massetti GM, Peaker B, Richardson LC. Invasive Cancer Incidence, 2004–2013, and Deaths, 2006–2015, in Nonmetropolitan and Metropolitan Counties—United States. Morb Mortal Wkly Rep Surveill Summ. 2017;66(14):1–13.

    PubMed  PubMed Central  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA

    Samilia Obeng-Gyasi MD, MPH, Lava Timsina PhD MPH & Carla S. Fisher MD

  2. Division of Surgical Oncology, The Ohio State University, Columbus, OH, USA

    Samilia Obeng-Gyasi MD, MPH

  3. Department of Economics, Indiana University Purdue University, Indianapolis, IN, USA

    Oindrila Bhattacharyya MSc

  4. VA Health Services Research and Development Center for Health Information and Communication, Indianapolis, IN, USA

    David A. Haggstrom MD MAS

  5. Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN, USA

    David A. Haggstrom MD MAS

  6. Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, USA

    David A. Haggstrom MD MAS

Authors
  1. Samilia Obeng-Gyasi MD, MPH
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  2. Lava Timsina PhD MPH
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  3. Oindrila Bhattacharyya MSc
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Correspondence to Samilia Obeng-Gyasi MD, MPH.

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Obeng-Gyasi, S., Timsina, L., Bhattacharyya, O. et al. Breast Cancer Presentation, Surgical Management and Mortality Across the Rural–Urban Continuum in the National Cancer Database. Ann Surg Oncol 27, 1805–1815 (2020). https://doi.org/10.1245/s10434-020-08376-y

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  • DOI: https://doi.org/10.1245/s10434-020-08376-y

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