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Simple transportation issues can have a big impact on breast cancer care: A new study finds that the farther away a woman lives from a radiation therapy facility, the less likely she is to undergo lumpectomy with radiation for early stage breast cancer.
Instead, many of these women will opt for a full mastectomy without radiation, Florida researchers report.
"This basically confirms previously reported information, and it's understandable, because radiation therapy requires going to the doctor for about five days a week for about six weeks," says Dr. Jay Brooks, chairman of hematology/oncology at the Ochsner Clinic Foundation in Baton Rouge, La.
"Even some of the newer techniques given over a three-week period of time still require driving back and forth. For many people who are older or poorer, transportation is a major issue," says Brooks, who was not involved in the study.
The findings may point to ways to make radiation feasible for more women, adds lead author Lydia Voti, deputy director of research for the Florida Cancer Data System at the University of Miami.
The study, appearing in the Jan. 1 issue of Cancer, also found that women who were older, of Hispanic origin or unmarried when they were diagnosed were less likely to get a lumpectomy plus radiation.
Breast-conserving surgical lumpectomy with radiation or a mastectomy without radiation are now the standard of care for tumors that have not spread beyond the breast. BCSR has been shown to be just as effective as mastectomy (removal of the entire breast) in terms of long-term survival.
"In general, mastectomy and breast-conserving surgery with radiation are accepted by the medical community as standards of care" for local breast cancers, Voti confirms. "It's preferable to do conservation if there are no contraindications, but many medical societies are recommending choice."
Choosing radiation is time-consuming and intensive, requiring multiple visits to a doctor's office or hospital. For women who live in remote areas, in particular, this may not be a feasible option.
Voti and her co-authors reviewed data from Florida's cancer registry, along with inpatient and outpatient data on 18,903 local breast carcinomas treated either with BCSR or mastectomy.
They found that the odds of receiving BCSR fell 3 percent for every five-mile increase in distance to the radiation facility.
Privately insured women were 49 percent more likely, and Medicare patients 37 percent more likely, to receive BCSR than uninsured women.
For every extra year of age, the odds of receiving BCSR decreased by 1 percent.
Hispanic women were 38 percent less likely to receive BCSR compared with white patients, while married women were 23 percent more likely to receive BCSR compared with single women.
For research purposes, being married is considered a surrogate for having good social support in dealing with breast cancer.
The researchers found no differences in the use of BCSR among separated, divorced or widowed women versus single women.
Admittedly, the issue of who does and who does not have health insurance is not easily solved, the researchers say.
But distance can be overcome, the experts say.
"If women are offered transportation, especially the women who live in areas that are more isolated and not near radiation therapy facilities, this can enhance the use of BCSR," Voti says. "That can probably be addressed easily. A lot of institutions do offer this type of facility, and they have better results in terms of the use of breast-conserving surgery."
And some women may choose a mastectomy even if they do not experience these obstacles to radiation.
"Mastectomies are not as deforming as they were previously," Brooks points out. "There is an acceptance more than there was 20 years ago. I am a tremendous proponent of allowing a woman to keep her breast. But sometimes, when you sit and talk to the patient, the family -- and even after you explain everything and show them pictures -- they still want it removed. There's nothing wrong with that."
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