title: Treatment of local breast carcinoma in Florida: the role of the distance to radiation therapy facilities.
abstract: BACKGROUND
  Breast-conserving surgery combined with radiation (BCSR) is the recommended alternative treatment to mastectomy for local breast carcinoma. However, limited access to healthcare may result in more extensive surgical treatment. The effect of distance to radiation therapy facilities on the likelihood of receiving BCSR was examined in Florida.
  
  
  METHODS
  Local breast carcinomas reported to Florida's statewide registry between July, 1997, and December, 2000 were linked to the Agency of Healthcare Administration inpatient and outpatient databases to supplement the registry's treatment data, resulting in 18,903 local breast carcinoma cases treated with BCSR or mastectomy. The odds of receiving BCSR were modeled as a function of distance to the closest radiation therapy facility, adjusting for health insurance, age, race/ethnicity, and marital status.
  
  
  RESULTS
  Distance to the closest radiation therapy facility was negatively associated with BCSR, with the odds ratio (OR) decreasing by 3% per 5-mile increase in distance. Compared with the uninsured, privately insured women were 49% more likely to receive BCSR (OR of 1.49; 95% confidence interval [95% CI], 1.20-1.86) and Medicare patients were 37% more likely (OR of 1.37; 95% CI, 1.09-1.72). Age at diagnosis was negatively associated, reducing the odds of BCSR by 1% per year increase in age. Compared with white non-Hispanic, Hispanic women were 38% less likely to receive BCSR (OR of 0.62; 95% CI, 0.55-0.71). Married women were 23% more likely to receive BCSR compared with singles (OR of 1.23; 95% CI, 1.09-1.40); women who were separated, divorced, or widowed did not differ significantly from single women.
  
  
  CONCLUSIONS
  Distance to radiation therapy facilities may negatively impact the likelihood of BCSR in Florida. Age at diagnosis, insurance type, race/ethnicity, and marital status were associated with BCSR. Future efforts should target the uninsured, Hispanics, the elderly, and the unmarried women to reduce disparities in the administration of BCSR for local breast carcinoma.
authors.affiliation: Florida Cancer Data System, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida 33101, USA. lydia_voti@miami.edu
authors.forename: Lydia
authors.initials: L
authors.lastname: Voti
authors.forename: Lisa C
authors.initials: LC
authors.lastname: Richardson
authors.forename: Isildinha M
authors.initials: IM
authors.lastname: Reis
authors.forename: Lora E
authors.initials: LE
authors.lastname: Fleming
authors.forename: Jill
authors.initials: J
authors.lastname: Mackinnon
authors.forename: Jan Willem W
authors.initials: JW
authors.lastname: Coebergh
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000208:ethnology / Q000532:radiotherapy* / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D005431:Florida / Q000453:epidemiology; D006297:Health Services Accessibility; D006630:Hispanic or Latino; D006801:Humans; D017533:Marital Status; D015412:Mastectomy, Segmental; D008875:Middle Aged; D018714:Radiotherapy, Adjuvant; D016896:Treatment Outcome