title: Travel distance and season of diagnosis affect treatment choices for women with early-stage breast cancer in a predominantly rural population (United States).
abstract: OBJECTIVE
  Current standards of care for early-stage breast cancer include either breast-conserving surgery (BCS) with post-operative radiation or mastectomy. A variety of factors influence the type of treatment chosen. In northern, rural areas, daily travel for radiation can be difficult in winter. We investigated whether proximity to a radiation treatment facility (RTF) and season of diagnosis affected treatment choice for New Hampshire women with early-stage breast cancer.
  
  
  METHODS
  Using a population-based cancer registry, we identified all women residents of New Hampshire diagnosed with stage I or II breast cancer during 1998-2000. We assessed factors influencing treatment choices using multivariate logistic regression.
  
  
  RESULTS
  New Hampshire women with early-stage breast cancer were less likely to choose BCS if they live further from a RTF (P < 0.001). Of those electing BCS, radiation was less likely to be used by women living >20 miles from a RTF (P = 0.002) and those whose diagnosis was made during winter (P = 0.031).
  
  
  CONCLUSIONS
  Our findings indicate that a substantial fraction of women with early-stage breast cancer in New Hampshire receive suboptimal treatment by forgoing radiation because of the difficulty traveling for radiation in winter. Future treatment planning strategies should consider these barriers to care in cold rural regions.
authors.affiliation: Department of Community, and the Norris Cotton Cancer Center, Dartmouth Medical School, Lebanon, NH, USA.
authors.forename: Maria O
authors.initials: MO
authors.lastname: Celaya
authors.forename: Judy R
authors.initials: JR
authors.lastname: Rees
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Gibson
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Riddle
authors.forename: E Robert
authors.initials: ER
authors.lastname: Greenberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001943:Breast Neoplasms / Q000175:diagnosis / Q000532:radiotherapy / Q000601:surgery; D002755:Choice Behavior; D005260:Female; D006268:Health Facilities; D006297:Health Services Accessibility; D006801:Humans; D015411:Mastectomy, Modified Radical / Q000706:statistics & numerical data; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data; D008875:Middle Aged; D009513:New Hampshire; D011878:Radiotherapy / Q000706:statistics & numerical data; D019035:Rural Health Services / Q000706:statistics & numerical data*; D012424:Rural Population; D012621:Seasons