title: Distance to Radiation Facility and Treatment Choice in Early-Stage Breast Cancer.
abstract: OBJECTIVE
  Breast-conserving therapy (BCT) is a recommended alternative to mastectomy (MT) for early-stage breast cancer. Limited access to radiation therapy (RT) may result in higher rates of MT. We assessed the association between distance to the nearest RT facility and the use of MT, in a modern cohort of women.
  
  
  METHODS
  Women with stage 0-II breast cancer eligible for BCT diagnosed from 2004 to 2010 were identified from the Florida Cancer Data System (FCDS). Distances from patient census tracts to the nearest RT facility census tract were calculated. Multivariate logistic regression was used to identify explanatory variables that influenced MT use.
  
  
  RESULTS
  Of the 27,489 eligible women, 32.1% (n=8841) underwent MT, and 67.8% (n=18,648) underwent BCS. Thirty-two percent of patients lived in a census tract that was >5 miles from an RT facility. MT use increased with increasing distance to RT facility (31.1% at ≤5 miles, 33.8% at >5 to <15 miles, 34.9% at 15 to <40 miles, and 51% at ≥40 miles, P<.001). The likelihood was that MT was independently associated with increasing distance to RT facility on multivariate analysis (P<.001). Compared to patients living <5 miles away from an RT facility, patients living 15 to <40 miles away were 1.2 times more likely to be treated with MT (odds ratio [OR]: 1.19, 95% confidence interval [CI]: 1.05-1.35, P<.01), and those living ≥40 miles away were more than twice as likely to be treated with MT (OR: 2.17, 95% CI: 1.48-3.17, P<.001). However, in patients younger than 50 years (n=5179), MT use was not associated with distance to RT facility (P=.235).
  
  
  CONCLUSIONS
  MT use in a modern cohort of women is independently associated with distance to RT facility. However, for young patients, distance to RT is not a significant explanatory variable for MT use.
authors.affiliation: Department of Radiation Oncology, Washington University School of Medicine-St. Louis, St. Louis, Missouri.
authors.forename: Sahaja
authors.initials: S
authors.lastname: Acharya
authors.affiliation: Department of Radiation Oncology, Washington University School of Medicine-St. Louis, St. Louis, Missouri.
authors.forename: Samantha
authors.initials: S
authors.lastname: Hsieh
authors.affiliation: Department of Radiation Oncology, Washington University School of Medicine-St. Louis, St. Louis, Missouri.
authors.forename: Jeff M
authors.initials: JM
authors.lastname: Michalski
authors.affiliation: Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Eric T
authors.initials: ET
authors.lastname: Shinohara
authors.affiliation: Department of Radiation Oncology, Washington University School of Medicine-St. Louis, St. Louis, Missouri. Electronic address: sperkins@radonc.wustl.edu.
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Perkins
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D002173:Cancer Care Facilities / Q000706:statistics & numerical data*; D019352:Censuses; 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; D016017:Odds Ratio; D012044:Regression Analysis; D012959:Socioeconomic Factors; D055815:Young Adult