Journal article
Effect of rurality and travel distance on contralateral prophylactic mastectomy for unilateral breast cancer
Cancer causes & control, v 34(Suppl 1), pp 171-186
01 Dec 2023
PMID: 37095280
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Purpose
Despite lack of survival benefit, demand for contralateral prophylactic mastectomy (CPM) to treat unilateral breast cancer remains high. High uptake of CPM has been demonstrated in Midwestern rural women. Greater travel distance for surgical treatment is associated with CPM. Our objective was to examine the relationship between rurality and travel distance to surgery with CPM.
Methods
Women diagnosed with stages I–III unilateral breast cancer between 2007 and 2017 were identified using the National Cancer Database. Logistic regression was used to model likelihood of CPM based on rurality, proximity to metropolitan centers, and travel distance. A multinomial logistic regression model compared factors associated with CPM with reconstruction versus other surgical options.
Results
Both rurality (OR 1.10, 95% CI 1.06–1.15 for non-metro/rural vs. metro) and travel distance (OR 1.37, 95% CI 1.33–1.41 for those who traveled 50 + miles vs. < 30 miles) were independently associated with CPM. For women who traveled 30 + miles, odds of receiving CPM were highest for non-metro/rural women (OR 1.33 for 30–49 miles, OR 1.57 for 50 + miles; reference: metro women traveling < 30 miles). Non-metro/rural women who received reconstruction were more likely to undergo CPM regardless of travel distance (ORs 1.11–1.21). Both metro and metro-adjacent women who received reconstruction were more likely to undergo CPM only if they traveled 30 + miles (ORs 1.24–1.30).
Conclusion
The impact of travel distance on likelihood of CPM varies by patient rurality and receipt of reconstruction. Further research is needed to understand how patient residence, travel burden, and geographic access to comprehensive cancer care services, including reconstruction, influence patient decisions regarding surgery.
Metrics
Details
- Title
- Effect of rurality and travel distance on contralateral prophylactic mastectomy for unilateral breast cancer
- Creators
- Madison M. Wahlen - University of IowaIngrid M. Lizarraga - University of Iowa Hospitals and ClinicsAmanda R. Kahl - Iowa Cancer RegistryWhitney E. Zahnd - University of IowaJan M. Eberth - Drexel UniversityLinda Overholser - University of Colorado DenverNatoshia Askelson - University of IowaRachel Hirschey - University of North Carolina at Chapel HillKatherine Yeager - Emory UniversitySarah Nash - University of IowaJacklyn M. Engelbart - University of Iowa Hospitals and ClinicsMary E. Charlton - University of Iowa
- Publication Details
- Cancer causes & control, v 34(Suppl 1), pp 171-186
- Publisher
- Springer International Publishing
- Grant note
- U48 DP006389; U48DP006399; U48 DP006377; U48 DP006400; U48DP006401 / Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion of the Centers for Disease Control and Prevention, U.S. Department of Health and Human Services (HHS) NIMHD K23 MD015719-01 / National Institute on Minority Health and Health Disparities (http://dx.doi.org/10.13039/100006545) HHSN261201800012I/HHSN26100001 / National Cancer Institute NIH T32 CA148062 / National Institutes of Health (http://dx.doi.org/10.13039/100000002)
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Health Management and Policy
- Web of Science ID
- WOS:000974764800001
- Scopus ID
- 2-s2.0-85153397276
- Other Identifier
- 991021855278204721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Oncology
- Public, Environmental & Occupational Health