November 28, 2005

Distance from Facility Affects Cancer Therapy

NEW YORK -- The distance a woman has to travel to reach a radiation therapy facility appears to influence whether she receives the recommended treatment for early-stage breast cancer, investigators report. Women who live farther away are also less likely to undergo breast-conserving surgery plus radiation as opposed to mastectomy.

Treatment guidelines recommend breast-conserving surgery plus radiation for early stage breast cancers. However, radiation treatment after surgery involves daily treatments for 5 to 6 consecutive weeks, Lydia Voti, at the University of Miami in Florida, and her colleagues explain.

To examine the factors that affect which treatment breast cancer patients receive, Voti and her associates used data from the Florida Cancer Data System and the Florida Agency for Health Care Administration to identify women with breast cancer treated between 1997 and 2000.

Of 18,903 cases identified, 7,549 women underwent mastectomy and 11,354 had breast-conserving surgery plus radiation, the investigators report in the medical journal Cancer.

Voti's group observed that "the distance to the closest radiation therapy facility was negatively associated with breast-conserving surgery plus radiation." The odds of undergoing breast-conserving surgery plus radiation decreased by about 3 percent for every 5-mile increase in the distance to the treatment facility.

Other factors associated with an increased risk of undergoing mastectomy included older age at diagnosis, being black or Hispanic compared with being white non-Hispanic, being single or widowed compared with being married or separated or divorced, and being uninsured or covered under Medicaid as opposed to having private or Medicare coverage.

"Future efforts should target the uninsured, Hispanics, the elderly, and unmarried women to reduce disparities in the administration of breast-conserving surgery plus radiation for local breast carcinoma," the researchers conclude.

SOURCE: Cancer, January 1, 2006.