Department of Epidemiology, University of Iowa, Iowa City, IA, USA.
Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
Cancer Causes Control. 2023 Dec;34(Suppl 1):171-186. doi: 10.1007/s10552-023-01689-9. Epub 2023 Apr 25.
Despite lack of survival benefit, demand for contralateral prophylactic mastectomy (CPM) to treat unilateral breast cancer remains high. High uptake of CPM has been demonstrated in Midwestern rural women. Greater travel distance for surgical treatment is associated with CPM. Our objective was to examine the relationship between rurality and travel distance to surgery with CPM.
Women diagnosed with stages I-III unilateral breast cancer between 2007 and 2017 were identified using the National Cancer Database. Logistic regression was used to model likelihood of CPM based on rurality, proximity to metropolitan centers, and travel distance. A multinomial logistic regression model compared factors associated with CPM with reconstruction versus other surgical options.
Both rurality (OR 1.10, 95% CI 1.06-1.15 for non-metro/rural vs. metro) and travel distance (OR 1.37, 95% CI 1.33-1.41 for those who traveled 50 + miles vs. < 30 miles) were independently associated with CPM. For women who traveled 30 + miles, odds of receiving CPM were highest for non-metro/rural women (OR 1.33 for 30-49 miles, OR 1.57 for 50 + miles; reference: metro women traveling < 30 miles). Non-metro/rural women who received reconstruction were more likely to undergo CPM regardless of travel distance (ORs 1.11-1.21). Both metro and metro-adjacent women who received reconstruction were more likely to undergo CPM only if they traveled 30 + miles (ORs 1.24-1.30).
The impact of travel distance on likelihood of CPM varies by patient rurality and receipt of reconstruction. Further research is needed to understand how patient residence, travel burden, and geographic access to comprehensive cancer care services, including reconstruction, influence patient decisions regarding surgery.
尽管没有生存获益，但是对于单侧乳腺癌治疗的对侧预防性乳房切除术（CPM）的需求仍然很高。在中西部农村妇女中，CPM 的接受率很高。接受 CPM 手术的患者往往需要长途跋涉。我们的目的是研究农村性和手术治疗距离与 CPM 之间的关系。
利用国家癌症数据库，确定了 2007 年至 2017 年间诊断为 I-III 期单侧乳腺癌的女性。采用逻辑回归模型，根据农村性、靠近大都市中心和旅行距离，对 CPM 的可能性进行建模。采用多项逻辑回归模型比较了与 CPM 相关的因素与重建与其他手术选择之间的关系。
农村性（非大都市/农村地区的比值比[OR]为 1.10，95%可信区间[CI]为 1.06-1.15）和旅行距离（旅行 50 英里以上的 OR 为 1.37，95%CI 为 1.33-1.41）与 CPM 独立相关。对于旅行 30 英里以上的女性，CPM 接受率最高的是非大都市/农村地区的女性（旅行 30-49 英里的 OR 为 1.33，旅行 50 英里以上的 OR 为 1.57；参考：大都市女性旅行<30 英里）。无论旅行距离如何，非大都市/农村地区接受重建的女性接受 CPM 的可能性更高（OR 1.11-1.21）。只有在旅行 30 英里以上的情况下，大都市和大都市周边接受重建的女性才更有可能接受 CPM（OR 1.24-1.30）。
旅行距离对 CPM 可能性的影响因患者的农村性和接受重建的情况而异。需要进一步研究以了解患者居住地、旅行负担以及获得全面癌症治疗服务（包括重建）的地理机会如何影响患者对手术的决策。
