The influence of travel time on breast cancer characteristics, receipt of primary therapy, and surveillance mammography |
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Authors: | Onega Tracy Cook Andrea Kirlin Beth Shi Xun Alford-Teaster Jennifer Tuzzio Leah Buist Diana S M |
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Institution: | (1) Department of Community and Family Medicine, Norris Cotton Cancer Center, The Dartmouth Institute for Health Policy and Clinical Practice, HB 7927 Rubin 8—DHMC, One Medical Center Dr, Lebanon, NH 03756, USA;(2) Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA;(3) Department of Biostatistics, University of Washington, Seattle, WA, USA;(4) Department of Geography, Dartmouth College, Hanover, NH, USA |
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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. |
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