title: The influence of travel time on breast cancer characteristics, receipt of primary therapy, and surveillance mammography.
abstract: Travel time has been shown to influence some aspects of cancer characteristics at diagnosis and care for women with breast cancer, but important gaps remain in our understanding of its impact. We examined the influence of travel time to the nearest radiology facility on breast cancer characteristics, treatment, and surveillance for women with early-stage invasive breast cancer. We included 1,012 women with invasive breast cancer (stages I and II) who had access to care within an integrated health care delivery system in western Washington State. The travel times to the nearest radiology facility were calculated for all the U.S. Census blocks within the study area and assigned to women based on residence at diagnosis. We collected cancer characteristics, primary and adjuvant therapies, and surveillance mammography for at least 2.5 years post diagnosis and used multivariable analyses to test the associations of travel time. The majority of women (68.6%) lived within 20 min of the nearest radiology facility, had stage I disease (72.7%), received breast conserving therapy (68.7%), and had annual surveillance mammography the first 2 years after treatment (73.7%). The travel time was not significantly associated with the stage or surveillance mammography after adjusting for covariates. Primary therapy was significantly related to travel time, with greater travel time (>30 min vs. ≤ 10 min) associated with a higher likelihood of mastectomy compared to breast conserving surgery (RR = 1.53; 95% CI, 1.16-2.01). The travel time was not associated with the stage at diagnosis or surveillance mammography receipt. The travel time does seem to influence the type of primary therapy among women with breast cancer, suggesting that women may prefer low frequency services, such as mastectomy, if geographic access to a radiology facility is limited.
authors.affiliation: Department of Community and Family Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH 03756, USA. onega@dartmouth.edu
authors.forename: Tracy
authors.initials: T
authors.lastname: Onega
authors.forename: Andrea
authors.initials: A
authors.lastname: Cook
authors.forename: Beth
authors.initials: B
authors.lastname: Kirlin
authors.forename: Xun
authors.initials: X
authors.lastname: Shi
authors.forename: Jennifer
authors.initials: J
authors.lastname: Alford-Teaster
authors.forename: Leah
authors.initials: L
authors.lastname: Tuzzio
authors.forename: Diana S M
authors.initials: DS
authors.lastname: Buist
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008327:Mammography; D008875:Middle Aged; D009367:Neoplasm Staging; D013997:Time Factors; D014195:Travel; D055815:Young Adult