Distance to radiation facilities has an inverse relationship with breast-conserving surgery with radiation use

The farther away a woman lives from a radiation therapy facility, the less likely she is to get lumpectomy with adjuvant radiation therapy for early stage breast cancer, and may instead get mastectomy, according to a new study.

Published in the January 1, 2006 issue of CANCER, a peer-reviewed journal of the American Cancer Society, the study reveals that being older, of Hispanic origin, or unmarried at diagnosis were also associated with decreased likelihood of treatment with lumpectomy and radiation therapy, and that both geographic accessibility and affordability of insurance influenced women's cancer treatment.

Mastectomy - a one-time surgery to remove all breast tissue along with the tumor - was once the only treatment option for women with early stage breast cancer. Breast-conserving surgery with radiation (BCSR) has been shown to be just as effective as mastectomy in terms of long time survival, but requires multiple follow-up visits for the radiation therapy. Despite professional recommendations that--unless there are contraindications--BCSR is the standard of care for localized breast cancer, studies show that women, particularly the elderly, ethnic minorities, and the uninsured, are less likely to receive BCSR. The conclusion often made is that affordability affects the receipt of BCSR. Studies of other cancers also implicate travel distance as a factor in access to treatment.

To determine whether travel distance from home to a radiation facility is an independent factor predicting BCSR use, Lydia Voti, DSc of the University of Miami and her colleagues reviewed inpatient and outpatient data for 18,903 breast cancer cases in Florida treated with BCSR or mastectomy.

The researchers found that the distance a woman had to travel to get treatment at a radiation facility independently impacted BCSR usage. The odds of receiving BCSR fell significantly for every 5-mile increase in the distance to a radiation treatment facility. Consistent with other studies, researchers found that socioeconomic factors, such as lack of health insurance, race-ethnicity (particularly Hispanic origin) and being unmarried also negatively impacted on the use of BCSR.

"We found that the distance to radiation therapy facilities has an inverse relationship with BCSR use," the authors conclude. They also recommend, "Facilitating access to radiation therapy facilities and offering pre-treatment counseling could potentially increase the receipt of BCSR among Hispanic and black women, older women, and the uninsured."