Distance to Care Facility Affects Mastectomy Rates

(Reuters Health) - The further a woman with breast cancer lives from a radiation therapy facility, the less likely she is to have breast-conserving therapy, a new study shows. Since 1990, Dr. Anneke T. Schroen of the University of Virginia in Charlottesville and her team note, breast conservation therapy has been considered the gold standard for women with early-stage breast cancer.

This type of therapy involves removing the tumor surgically along with any cancer-containing lymph nodes, followed by radiation treatment. In mastectomy, a more debilitating and disfiguring surgery that is not always necessary, the entire breast as well as some surrounding tissue is removed. While breast conservation therapy is being used more frequently in the US as a whole, Schroen and her colleagues write in the Journal of Clinical Oncology, rates are lower in portions of the southern US. But the reason for this regional variation is unclear.

The team conducted the current study to investigate whether access to care, as measured by distance from the nearest radiation therapy facility, might affect breast cancer therapy. Virginia offers an excellent opportunity for evaluating access to treatment and quality of care, the researchers note, given that it encompasses both urban and rural areas and poor and wealthy populations.

Their analysis included 20,094 patients diagnosed with breast cancer in Virginia between 1996 and 2000. While mastectomy rates were 43 percent for women who lived within 10 miles of a radiation therapy facility, they were 47 percent among women living 10 to 25 miles from a facility, 53 percent at 25 to 50 miles, and 58 percent at greater than 50 miles.

The same relationship was seen for the women who had small, early stage tumors, with mastectomy rates being 31 percent, 36 percent, 41 percent and 49 percent, respectively. During the course of the study, the researchers found, overall mastectomy rates dropped from 48 percent to 43 percent across the state.

In a rural area where a new radiation therapy facility was opened, rates dropped from 61 percent to 45 percent in the same time period. While it may not be cost-effective to site new radiation therapy facilities in rural areas, Dr. Schroen and her team note, another possibility for improving access for rural women would be to provide housing assistance near existing facilities. The findings suggest, they conclude, that improving access to radiation therapy could help to increase rates of breast-conserving treatment.

SOURCE: Journal of Clinical Oncology, October 1, 2005.
Copyright 2005 Reuters.