Effect of rurality and travel distance on contralateral prophylactic mastectomy for unilateral breast cancer

• Type of Material: Article
• Authors: Madison M. Wahlen, University of Iowa; Ingrid M. Lizarraga, University of Iowa; Amanda R. Kahl, Iowa Cancer Registry; Whitney E. Zahnd, University of Iowa; Jan M. Eberth, University of South Carolina, Columbia; Linda Overholser, University of Colorado, Aurora; Natoshia Askelson, University of Iowa; Rachel Hirschey, University of North Carolina, Chapel Hill; Katherine Yeager, Emory University; Sarah Nash, University of Iowa; Jacklyn M. Engelbart, University of Iowa; Mary E. Charlton, University of Iowa
• Language: English
• Date: 2023-04-25
• Publisher: Springer Nature
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2023
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): https://doi.org/10.1007/s10552-023-01689-9
• Title of Journal or Parent Work: Cancer Causes and Control
• Volume: 34
• Start Page: 171
• End Page: 186
• Grant/Funding Information: This project is also supported in part by the National Cancer Institute [HHSN261201800012I/ HHSN26100001, NIH/NCI P30 CA086862, and NIH T32 CA148062] and the National Institute on Minority Health and Health Disparities [NIMHD K23 MD015719-01].; Work on this paper was funded in part by the 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) under Cooperative Agreement Numbers [U48 DP006389, U48DP006399, U48 DP006377, U48 DP006400, U48DP006401].
• Keywords: Travel distance; Rurality; Contralateral prophylactic mastectomy
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Public Health

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.