Goyal Sharad, Chandwani Sheenu, Haffty Bruce G, Demissie Kitaw
Department of Radiation Oncology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA,
Ann Surg Oncol. 2015 Apr;22(4):1095-101. doi: 10.1245/s10434-014-4093-8. Epub 2014 Sep 23.
Breast-conserving surgery (BCS) followed by adjuvant radiation therapy (RT) is the standard of care for women with early-stage breast cancer as an alternative to mastectomy. The purpose of this study was to examine the relationship between receipt of mastectomy and travel distance and time to RT facility in New Jersey (NJ).
Data were collected from a cohort of 634 NJ women diagnosed with early-stage breast cancer. In patients receiving RT, the precise RT facility was used, whereas in patients not receiving RT, surgeons were contacted to determine the location of RT referral. Travel distance and time to RT facility from the patients' residential address were modeled separately using multiple binomial regression to examine their association with choice of surgery while adjusting for clinical and sociodemographic factors.
Overall, 58.5 % patients underwent BCS with median travel distance to the radiation facility of 4.8 miles (vs. 6.6 miles for mastectomy) and median travel time of 12.0 min (vs. 15.0 min for mastectomy). Patients residing > 9.2 miles compared with ≤ 9.2 miles from radiation facility were 44 % more likely to receive mastectomy. Additionally, patients requiring > 19 min compared with ≤ 19 min of travel time were 36 % more likely to receive mastectomy.
These data found that travel distance and time from RT facility act as barriers to undergoing BCS in women with early-stage breast cancer. Despite being in an urban region, a significant number of women in NJ with early-stage breast cancer did not receive BCS.
保乳手术（BCS）联合辅助放疗（RT）是早期乳腺癌女性患者的标准治疗方案，可替代乳房切除术。本研究旨在探讨在新泽西州（NJ）接受乳房切除术与前往放疗机构的距离和时间之间的关系。
收集了634名被诊断为早期乳腺癌的NJ女性队列的数据。对于接受放疗的患者，使用确切的放疗机构；而对于未接受放疗的患者，联系外科医生以确定放疗转诊的地点。使用多项二项式回归分别对患者居住地址到放疗机构的旅行距离和时间进行建模，以在调整临床和社会人口学因素的同时，检验它们与手术选择的关联。
总体而言，58.5%的患者接受了保乳手术，到放疗机构的中位旅行距离为4.8英里（乳房切除术为6.6英里），中位旅行时间为12.0分钟（乳房切除术为15.0分钟）。居住在距离放疗机构>9.2英里的患者与≤9.2英里的患者相比，接受乳房切除术的可能性高44%。此外，旅行时间>19分钟的患者与≤19分钟的患者相比，接受乳房切除术的可能性高36%。
这些数据发现，到放疗机构的旅行距离和时间是早期乳腺癌女性接受保乳手术的障碍。尽管处于城市地区，但NJ仍有相当数量的早期乳腺癌女性未接受保乳手术。
