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Breast Cancer Stage at Diagnosis: Is Travel Time Important?

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Abstract

Recent studies have produced inconsistent results in their examination of the potential association between proximity to healthcare or mammography facilities and breast cancer stage at diagnosis. Using a multistate dataset, we re-examine this issue by investigating whether travel time to a patient’s diagnosing facility or nearest mammography facility impacts breast cancer stage at diagnosis. We studied 161,619 women 40 years and older diagnosed with invasive breast cancer from ten state population based cancer registries in the United States. For each woman, we calculated travel time to their diagnosing facility and nearest mammography facility. Logistic multilevel models of late versus early stage were fitted, and odds ratios were calculated for travel times, controlling for age, race/ethnicity, census tract poverty, rural/urban residence, health insurance, and state random effects. Seventy-six percent of women in the study lived less than 20 min from their diagnosing facility, and 93 percent lived less than 20 min from the nearest mammography facility. Late stage at diagnosis was not associated with increasing travel time to diagnosing facility or nearest mammography facility. Diagnosis age under 50, Hispanic and Non-Hispanic Black race/ethnicity, high census tract poverty, and no health insurance were all significantly associated with late stage at diagnosis. Travel time to diagnosing facility or nearest mammography facility was not a determinant of late stage of breast cancer at diagnosis, and better geographic proximity did not assure more favorable stage distributions. Other factors beyond geographic proximity that can affect access should be evaluated more closely, including facility capacity, insurance acceptance, public transportation, and travel costs.

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Acknowledgements

The authors thank Charlie Blackburn and Dr. John Wilson for project oversight and Rich Pinder, and staff of the University of Southern California GIS Research Laboratory for technical input. The authors would also like to thank staff at the participating cancer registries for providing their data and to NAVTEQ for the generous donation of the reference street network used for these analyses.

Financial Support

This research was supported by a grant from Susan G. Komen for the Cure to the North American Association of Central Cancer Registries (NAACCR). The sponsor had no involvement in the study design or analysis.

Disclaimer

The findings and conclusions in this paper are those of the author(s) and do not necessarily represent the official position of Susan G. Komen for the Cure.

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Authors and Affiliations

  1. Cancer Institute of New Jersey, New Jersey State Cancer Registry, New Brunswick, NJ, 08901, USA

    Kevin A. Henry

  2. New York State Cancer Registry, 150 Broadway Suite 361, Menands, NY, 12204, USA

    Francis P. Boscoe

  3. Cancer Data Registry of Idaho, Boise, ID, 83702, USA

    Christopher J. Johnson

  4. Spatial Sciences Institute, University of Southern California, Los Angeles, CA, 90089-0374, USA

    Daniel W. Goldberg

  5. Florida Cancer Data System, University of Miami Miller Medical School, Miami, FL, 33101, USA

    Recinda Sherman

  6. Keck School of Medicine, University of Southern California, 1441 Eastlake Ave, Los Angeles, CA, 90089, USA

    Myles Cockburn

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  1. Kevin A. Henry
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  2. Francis P. Boscoe
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Correspondence to Kevin A. Henry or Francis P. Boscoe.

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Henry, K.A., Boscoe, F.P., Johnson, C.J. et al. Breast Cancer Stage at Diagnosis: Is Travel Time Important?. J Community Health 36, 933–942 (2011). https://doi.org/10.1007/s10900-011-9392-4

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