title: Geographic proximity to treatment for early stage breast cancer and likelihood of mastectomy.
abstract: OBJECTIVE
  Women with early stage breast cancer who live far from a radiation therapy facility may be more likely to opt for mastectomy over breast conserving surgery (BCS). The geographic dimensions of this relationship deserve further scrutiny.
  
  
  METHODS
  For over 100,000 breast cancer patients in 10 states who received either mastectomy or BCS, a newly-developed software tool was used to calculate the shortest travel distance to the location of surgery and to the nearest radiation treatment center. The likelihood of receipt of mastectomy was modeled as a function of these distance measures and other demographic variables using multilevel logistic regression.
  
  
  RESULTS
  Women traveling over 75 km for treatment are about 1.4 times more likely to receive a mastectomy than those traveling under 15 km.
  
  
  CONCLUSIONS
  Geographic barriers to optimal breast cancer treatment remain a valid concern, though most women traveling long distances to receive mastectomies are doing so after bypassing local options.
authors: New York State Cancer Registry, Menands, NY 12204, USA. fpb01@health.state.ny.us
authors: Francis P
authors: FP
authors: Boscoe
authors: Christopher J
authors: CJ
authors: Johnson
authors: Kevin A
authors: KA
authors: Henry
authors: Daniel W
authors: DW
authors: Goldberg
authors: Kaveh
authors: K
authors: Shahabi
authors: Elena B
authors: EB
authors: Elkin
authors: Leslie K
authors: LK
authors: Ballas
authors: Myles
authors: M
authors: Cockburn
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D002755:Choice Behavior; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008408:Mastectomy / Q000706:statistics & numerical data*; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data; D008875:Middle Aged; D009367:Neoplasm Staging; D012111:Residence Characteristics; D014195:Travel / Q000706:statistics & numerical data*; D014481:United States; D016387:Women's Health