Bridging the Gap: Transforming Knowledge into Action
July 8-12, 2006, Washington, DC, USA
Monday, 10 July 2006 - 12:00 PM 84-94
The Role of the Distance to Radiation Therapy Facilities in the Treatment of Local Breast Cancer
Lydia Voti, DSc1, Lisa C. Richardson, MD, MPH2, Isildhina Reis, DrPH3, Lora E. Fleming4, Jill Mackinnon, PhD1, and Jan Willem W. Coebergh, MD, PhD5. (1) Florida Cancer Data System, University of Miami, PO Box 016960 (D4-11), Miami, FL 33131, (2) US Centers for Disease Control and Prevention, Division of Cancer Prevention and Control, 4770 Buford Highway, NE, Atlanta, GA 30341, (3) Division of Biostatistics, SCCC and Department of Epidemiology and Public Health, University of Miami, PO Box 016960 (D4-11), Fox 305, Miami, FL 33131, (4) Epidemiology and Public Health, University of Miami Miller School of Medicine, P.O. Box 016069 (R-669), Miami, FL 33143, (5) Department of Public Health, Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, Rotterdam, Netherlands
Objective: Breast conserving surgery combined with radiation (BCSR), the recommended alternative treatment to mastectomy for local breast cancer, may not be used as widely as it could due to limited access to healthcare. We assessed the role of geographic access to care and healthcare insurance type, in addition to other factors. Methods: Local breast cancers reported to Florida's registry were linked to the Agency of Healthcare Administration inpatient and outpatient databases, to supplement the registry's treatment data, resulting in 18,903 cases treated with BCSR or mastectomy. The odds of receiving BCSR were modeled as a function of distance to the closest radiation therapy facility, adjusting for health insurance, age, race/ethnicity and marital status. Results: Distance to the closest radiation therapy facility decreased the odds of BCSR by 3% per 5-mile increase. Compared to the uninsured, privately insured women were 49% more likely to receive BCSR and Medicare patients were 37% more likely. Each year increase in age at diagnosis reduced the odds of BCSR by 1%. Compared to white non-Hispanic, Hispanic women were 38% less likely to receive BCSR. Married women were 23% more likely to receive BCSR compared to singles.