Cancer Institute of New Jersey, New Jersey State Cancer Registry, New Brunswick, NJ 08901, USA.
J Community Health. 2011 Dec;36(6):933-42. doi: 10.1007/s10900-011-9392-4.
Recent studies have produced inconsistent results in their examination of the potential association between proximity to healthcare or mammography facilities and breast cancer stage at diagnosis. Using a multistate dataset, we re-examine this issue by investigating whether travel time to a patient's diagnosing facility or nearest mammography facility impacts breast cancer stage at diagnosis. We studied 161,619 women 40 years and older diagnosed with invasive breast cancer from ten state population based cancer registries in the United States. For each woman, we calculated travel time to their diagnosing facility and nearest mammography facility. Logistic multilevel models of late versus early stage were fitted, and odds ratios were calculated for travel times, controlling for age, race/ethnicity, census tract poverty, rural/urban residence, health insurance, and state random effects. Seventy-six percent of women in the study lived less than 20 min from their diagnosing facility, and 93 percent lived less than 20 min from the nearest mammography facility. Late stage at diagnosis was not associated with increasing travel time to diagnosing facility or nearest mammography facility. Diagnosis age under 50, Hispanic and Non-Hispanic Black race/ethnicity, high census tract poverty, and no health insurance were all significantly associated with late stage at diagnosis. Travel time to diagnosing facility or nearest mammography facility was not a determinant of late stage of breast cancer at diagnosis, and better geographic proximity did not assure more favorable stage distributions. Other factors beyond geographic proximity that can affect access should be evaluated more closely, including facility capacity, insurance acceptance, public transportation, and travel costs.
最近的研究在检查靠近医疗保健或乳房 X 光设施与诊断时乳腺癌分期之间的潜在关联时，得出了不一致的结果。我们使用多状态数据集，通过调查患者诊断设施或最近的乳房 X 光设施的旅行时间是否会影响诊断时的乳腺癌分期，重新研究了这个问题。我们研究了来自美国十个州的基于人群的癌症登记处的 161619 名 40 岁及以上被诊断患有浸润性乳腺癌的女性。对于每位女性，我们计算了到达其诊断设施和最近的乳房 X 光设施的旅行时间。针对旅行时间，我们拟合了晚期与早期阶段的逻辑多层模型，并计算了比值比，同时控制了年龄、种族/族裔、普查区贫困、城乡居住、医疗保险和州随机效应。在研究中，76%的女性居住在距离其诊断设施不到 20 分钟的地方，93%的女性居住在距离最近的乳房 X 光设施不到 20 分钟的地方。诊断时处于晚期与到达诊断设施或最近的乳房 X 光设施的旅行时间增加无关。诊断年龄在 50 岁以下、西班牙裔和非西班牙裔黑人种族/族裔、普查区贫困程度高以及没有医疗保险，均与晚期诊断显著相关。到达诊断设施或最近的乳房 X 光设施的旅行时间并不是诊断时晚期乳腺癌的决定因素，更好的地理位置接近并不能保证更有利的分期分布。应该更密切地评估除地理位置接近之外可能影响获得治疗的其他因素，包括设施容量、保险接受程度、公共交通和旅行成本。
