title: Rural-urban differences in radiation therapy for ductal carcinoma in-situ of the breast.
abstract: OBJECTIVE
  Rural women in the United States are at a documented disadvantage with regard to breast cancer detection, diagnosis, and treatment and generally do not receive state-of-the-art therapy. The objective of the study was to determine if, and to what extent, rural women were less likely to receive radiation therapy (XRT) following breast conserving surgery (BCS) for ductal carcinoma in-situ (DCIS).
  
  
  METHODS
  Our analyses were based on 1991-1996 data provided by the Surveillance, Epidemiology, and End Results (SEER) Program. Only women who were diagnosed with their first primary, microscopically confirmed DCIS breast cancer were included. BCS and XRT were defined according to SEER definitions. Multiple logistic regression was used in the analysis.
  
  
  RESULTS
  During this time period, 6,988 women were treated with BCS for DCIS, 50.1% of whom received XRT. In multivariate analysis, rural women in general (OR = 0.58) and younger women (<65) in particular (OR = 0.38) were less likely to receive XRT. Local availability of XRT was not associated with receipt among younger women, while older women without this availability were less likely to receive XRT (OR = 0.48).
  
  
  CONCLUSIONS
  Barriers to XRT following BCS for DCIS may be different between younger and older rural women relative to their urban counterparts.
authors.affiliation: Department of Pediatrics, Washington University School of Medicine, Saint Louis, MO, USA. mschootm@im.wustl.edu
authors.forename: M
authors.initials: M
authors.lastname: Schootman
authors.forename: R
authors.initials: R
authors.lastname: Aft
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000453:epidemiology / Q000532:radiotherapy*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000453:epidemiology / Q000532:radiotherapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D012424:Rural Population / Q000706:statistics & numerical data*; D018426:SEER Program; D014481:United States / Q000453:epidemiology