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Cancer Causes Control (2006) 17:851856DOI 10.1007/s10552-006-0025-7ORIGINAL PAPERTravel distance and season of diagnosis affect treatment choices
for women with early-stage breast cancer in a predominantly
rural population (United States)Maria O. Celaya Judy R. Rees Jennifer J. Gibson Bruce L. Riddle E. Robert GreenbergReceived: 9 March 2005 / Accepted: 2 June 2005
Springer Science+Buisness Media B.V. 2006AbstractObjective Current standards of care for early-stage breastcancer include either breast-conserving surgery (BCS) withpost-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 inwinter. We investigated whether proximity to a radiationtreatment facility (RTF) and season of diagnosis affectedtreatment choice for New Hampshire women with earlystage breast cancer.Methods Using a population-based cancer registry, weidentified all women residents of New Hampshire diagnosed with stage I or II breast cancer during 19982000.We assessed factors influencing treatment choices usingmultivariate logistic regression.Results New Hampshire women with early-stage breastcancer were less likely to choose BCS if they live furtherfrom a RTF (P < 0.001). Of those electing BCS, radiationwas less likely to be used by women living >20 miles froma RTF (P = 0.002) and those whose diagnosis was madeduring winter (P = 0.031).Conclusion Our findings indicate that a substantial fraction of women with early-stage breast cancer in NewHampshire receive suboptimal treatment by forgoingradiation because of the difficulty traveling for radiation inwinter. Future treatment planning strategies should consider these barriers to care in cold rural regions.Keywords Breast cancer Breast-conserving surgery Geographic factors Radiotherapy SeasonIntroductionMost women with early-stage breast cancer have a choicebetween two roughly equivalent treatment options: eitherbreast conserving surgery (BCS) followed by radiationtherapy (RT), or a modified radical mastectomy (MRM) [1,2]. Both approaches have been shown in randomizedclinical trials to result in similar long-term survival [36].BCS without subsequent radiation carries an increased riskof local recurrence, and current guidelines recommendagainst this approach [2].Previous studies have shown that the use of BCS andpost-operative radiation is influenced by age [710], psycho-social factors [1113], and hospital characteristics[1417]. Ease of access to treatment may also affecttreatment choice for rural patients with cancer [12, 1821].Geographic factors, particularly proximity of treatmentfacilities to patients residence may play a role in treatmentchoice for rural patients with cancer. In a study of lungcancer patients in New Hampshire and Vermont, Greenberg et...