Voti Lydia, Richardson Lisa C, Reis Isildinha M, Fleming Lora E, Mackinnon Jill, Coebergh Jan Willem W
Florida Cancer Data System, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida 33101, USA.
Cancer. 2006 Jan 1;106(1):201-7. doi: 10.1002/cncr.21557.
BACKGROUND: Breast-conserving surgery combined with radiation (BCSR) is the recommended alternative treatment to mastectomy for local breast carcinoma. However, limited access to healthcare may result in more extensive surgical treatment. The effect of distance to radiation therapy facilities on the likelihood of receiving BCSR was examined in Florida. METHODS: Local breast carcinomas reported to Florida's statewide registry between July, 1997, and December, 2000 were linked to the Agency of Healthcare Administration inpatient and outpatient databases to supplement the registry's treatment data, resulting in 18,903 local breast carcinoma 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 was negatively associated with BCSR, with the odds ratio (OR) decreasing by 3% per 5-mile increase in distance. Compared with the uninsured, privately insured women were 49% more likely to receive BCSR (OR of 1.49; 95% confidence interval [95% CI], 1.20-1.86) and Medicare patients were 37% more likely (OR of 1.37; 95% CI, 1.09-1.72). Age at diagnosis was negatively associated, reducing the odds of BCSR by 1% per year increase in age. Compared with white non-Hispanic, Hispanic women were 38% less likely to receive BCSR (OR of 0.62; 95% CI, 0.55-0.71). Married women were 23% more likely to receive BCSR compared with singles (OR of 1.23; 95% CI, 1.09-1.40); women who were separated, divorced, or widowed did not differ significantly from single women. CONCLUSIONS: Distance to radiation therapy facilities may negatively impact the likelihood of BCSR in Florida. Age at diagnosis, insurance type, race/ethnicity, and marital status were associated with BCSR. Future efforts should target the uninsured, Hispanics, the elderly, and the unmarried women to reduce disparities in the administration of BCSR for local breast carcinoma.
背景：保乳手术联合放疗（BCSR）是局部乳腺癌推荐的替代乳房切除术的治疗方法。然而，医疗保健服务可及性有限可能导致更广泛的手术治疗。在佛罗里达州，研究了与放疗设施的距离对接受BCSR可能性的影响。 方法：1997年7月至2000年12月间向佛罗里达州全州登记处报告的局部乳腺癌病例与医疗保健管理局的住院和门诊数据库相链接，以补充登记处的治疗数据，从而得到18903例接受BCSR或乳房切除术治疗的局部乳腺癌病例。接受BCSR的几率被建模为与距离最近放疗设施的函数关系，并对健康保险、年龄、种族/族裔和婚姻状况进行了调整。 结果：与距离最近放疗设施的距离与BCSR呈负相关，距离每增加5英里，优势比（OR）下降3%。与未参保女性相比，私人保险女性接受BCSR的可能性高49%（OR为1.49；95%置信区间[95%CI]，1.20 - 1.86），医疗保险患者高37%（OR为1.37；95%CI，1.09 - 1.72）。诊断时年龄与BCSR呈负相关，年龄每增加一岁，接受BCSR的几率降低1%。与非西班牙裔白人相比，西班牙裔女性接受BCSR的可能性低38%（OR为0.62；95%CI，0.55 - 0.71）。已婚女性接受BCSR的可能性比单身女性高23%（OR为1.23；95%CI，1.09 - 1.40）；分居、离婚或丧偶的女性与单身女性相比无显著差异。 结论：在佛罗里达州，与放疗设施的距离可能对BCSR的可能性产生负面影响。诊断时年龄、保险类型、种族/族裔和婚姻状况与BCSR有关。未来的努力应针对未参保者、西班牙裔、老年人和未婚女性，以减少局部乳腺癌BCSR管理方面的差异。
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