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The influence of travel time on breast cancer characteristics, receipt of primary therapy, and surveillance mammography

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Abstract

Travel time has been shown to influence some aspects of cancer characteristics at diagnosis and care for women with breast cancer, but important gaps remain in our understanding of its impact. We examined the influence of travel time to the nearest radiology facility on breast cancer characteristics, treatment, and surveillance for women with early-stage invasive breast cancer. We included 1,012 women with invasive breast cancer (stages I and II) who had access to care within an integrated health care delivery system in western Washington State. The travel times to the nearest radiology facility were calculated for all the U.S. Census blocks within the study area and assigned to women based on residence at diagnosis. We collected cancer characteristics, primary and adjuvant therapies, and surveillance mammography for at least 2.5 years post diagnosis and used multivariable analyses to test the associations of travel time. The majority of women (68.6%) lived within 20 min of the nearest radiology facility, had stage I disease (72.7%), received breast conserving therapy (68.7%), and had annual surveillance mammography the first 2 years after treatment (73.7%). The travel time was not significantly associated with the stage or surveillance mammography after adjusting for covariates. Primary therapy was significantly related to travel time, with greater travel time (>30 min vs. ≤ 10 min) associated with a higher likelihood of mastectomy compared to breast conserving surgery (RR = 1.53; 95% CI, 1.16–2.01). The travel time was not associated with the stage at diagnosis or surveillance mammography receipt. The travel time does seem to influence the type of primary therapy among women with breast cancer, suggesting that women may prefer low frequency services, such as mastectomy, if geographic access to a radiology facility is limited.

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Acknowledgments

This study was funded by Group Health Research Institute, and the Cancer Research Network (CRN) through grant 5U19CA079689-10, “Cancer Research Network Across Health Care Systems Pilot Funds.” We would like to extend our thanks to Edward H. Wagner, MD, and MPH for making these funds available.

Conflict of interest

The authors have no conflicts of interest to declare.

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Authors and Affiliations

  1. Department of Community and Family Medicine, Norris Cotton Cancer Center, The Dartmouth Institute for Health Policy and Clinical Practice, HB 7927 Rubin 8—DHMC, One Medical Center Dr, Lebanon, NH, 03756, USA

    Tracy Onega

  2. Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA

    Andrea Cook, Beth Kirlin, Leah Tuzzio & Diana S. M. Buist

  3. Department of Biostatistics, University of Washington, Seattle, WA, USA

    Andrea Cook

  4. Department of Geography, Dartmouth College, Hanover, NH, USA

    Xun Shi & Jennifer Alford-Teaster

Authors
  1. Tracy Onega
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  2. Andrea Cook
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  3. Beth Kirlin
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  4. Xun Shi
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  5. Jennifer Alford-Teaster
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  6. Leah Tuzzio
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  7. Diana S. M. Buist
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Correspondence to Tracy Onega.

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Onega, T., Cook, A., Kirlin, B. et al. The influence of travel time on breast cancer characteristics, receipt of primary therapy, and surveillance mammography. Breast Cancer Res Treat 129, 269–275 (2011). https://doi.org/10.1007/s10549-011-1549-4

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  • DOI: https://doi.org/10.1007/s10549-011-1549-4

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