Travel Distance Might Affect Breast Cancer Treatment

The distance a woman with breast cancer has to travel to receive treatment may affect how she is treated, according to a recent study by Medical College of Wisconsin researchers.

The use of breast-conserving surgery (BCS) for patients with early-stage breast cancer varies widely from region to region within the US. BCS is less invasive than a mastectomy, which removes the entire breast rather than only the area around the tumor site. Moreover, BCS is just as effective as mastectomy in treating breast cancer when followed by radiation therapy of the tumor site. Previous studies have shown, however, that many patients undergoing BCS do not receive radiation therapy. Typically, radiation therapy is given five days per week for 5-6 weeks.

Other studies have shown that patients are more likely to receive breast-conserving surgery if they live in an urban area or are treated at a hospital that has radiation therapy available onsite. MCW researchers wondered if distance might play a role in who receives BCS and who receives radiation after BCS.

MCW researchers, including Ronald T. Kneusel, MS, Raymond G. Hoffman, PhD, and Mary Ann C. Gilligan, MD, examined a national database, the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) patient registry. A total of 17,729 women were included in their review. These women were ages 30 and older at the time of first diagnosis of early-stage breast cancer in 1991 or 1992 and who underwent mastectomy or BCS. (The necessary census data were not available for years after 1992).

Of the 7,384 patients who underwent BCS, about 75% received radiation therapy. The median distance from a hospital with a radiation therapy facility was 4.1 miles (meaning that an equal number of patients were less than 4.1 miles from such a facility and an equal number were more than 4.1 miles from a radiation facility). Almost 90% of patients lived within 15 miles of a hospital with a radiation treatment facility.

The study found that patients who lived an increased distance from a hospital with a radiation therapy facility were less likely to undergo BCS. This was particularly true of women residing 15 miles or more from the nearest hospital with a radiation facility. Surprisingly, the results for women 65 or older, who may have even more difficulty with transportation, were virtually the same.

In addition, women who lived 40 miles or more from a radiation therapy site were less likely to receive radiation after BCS. However, distance alone did not account for all the variation in treatment from one geographic area to another seen in other studies, or for the fact that women in urban areas are more likely to receive BCS as treatment. An unmeasured factor, perhaps dealing with the available health care system in an area, may be an issue.

It should be noted that the decreased use of breast-conserving surgery among patients living 15 miles or more from a radiation facility does not necessarily mean that these women did not receive appropriate care. A modified radical mastectomy, for example, is also appropriate for women with early-stage breast cancer.

However, the finding that BCS patients living at least 40 miles from a radiation therapy site are less likely to receive radiation is cause for concern. For women who undergo BCS, radiation therapy is clearly recommended. Those BCS patients who don't receive radiation have reoccurring breast tumors about 35% of the time over a five-year period.

The good news is that only 3.1% of the entire study and 1.7% of the study's BCS patients lived 40 miles or more from a hospital with radiation facilities. No matter where they live in relation to their treatment facility, patients with early-stage breast cancer should be sure to discuss the possibility of breast-conserving surgery with their physician. Furthermore, BCS patients should be sure to follow through on radiation treatments after the procedure even if they have to travel some distance to do so.

The study by Dr. Nattinger and her team was published in the Sept. 5, 2001, issue of the Journal of the National Cancer Institute, Vol. 93, No. 17, p. 1344-1346.

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.