Impact of age, rurality and distance in predicting contralateral prophylactic mastectomy for breast cancer in a Midwestern state: a population-based study

Ingrid M Lizarraga; Amanda R Kahl; Ellie Jacoby; Mary E Charlton; Charles F Lynch; Sonia L Sugg

doi:10.1007/s10549-021-06105-x

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Impact of age, rurality and distance in predicting contralateral prophylactic mastectomy for breast cancer in a Midwestern state: a population-based study

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Impact of age, rurality and distance in predicting contralateral prophylactic mastectomy for breast cancer in a Midwestern state: a population-based study

Ingrid M Lizarraga, Amanda R Kahl, Ellie Jacoby, Mary E Charlton, Charles F Lynch and Sonia L Sugg

Breast cancer research and treatment, Vol.188(1), pp.191-202

02/13/2021

DOI: 10.1007/s10549-021-06105-x

PMCID: PMC8238858

PMID: 33582888

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https://www.ncbi.nlm.nih.gov/pmc/articles/8238858View

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Abstract

Iowa is among several rural Midwestern states with the highest proportions of contralateral prophylactic mastectomy (CPM) in women < 45 years of age. We evaluated the role of rurality and travel distance in these surgical patterns. Women with unilateral breast cancer (2007-2017) were identified using Iowa Cancer Registry records. Patients and treating hospitals were classified as metro, nonmetro, and rural based on Rural-Urban Continuum Codes. Differences in patient, tumor, and treatment characteristics and median travel distance (MTD) were compared. Characteristics associated with CPM were evaluated with multivariate logistic regression. 22,158 women were identified: 57% metro, 26% nonmetro and 18% rural. Young rural women had the highest proportion of CPM (52%, 39% and 40% for rural, metro, nonmetro women < 40 years). Half of all rural women had surgery at metro hospitals; these women had the longest MTD (62 miles). Among all women treated at metro hospitals, rural women had the highest proportion of CPM (17% rural vs 14% metro/nonmetro, p = 0.007). On multivariate analysis, traveling ≥ 50 miles (ORs 1.43-2.34) and rural residence (OR = 1.29) were independently predictive of CPM. Other risk factors were young age (< 40 years: OR = 7.28, 95% CI 5.97-8.88) and surgery at a metro hospital that offers reconstruction (OR = 2.30, 95% CI 1.65-3.21) and is not NCI-designated (OR = 2.34, 95% CI 1.92-2.86). There is an unexpectedly high proportion of CPM in young rural women in Iowa, and travel distance and availability of reconstructive services likely influence decision-making. Improving access to multidisciplinary care in rural states may help optimize decision-making.

Rural

Breast cancer

Travel distance

Contralateral prophylactic mastectomy

Details

Title: Subtitle: Impact of age, rurality and distance in predicting contralateral prophylactic mastectomy for breast cancer in a Midwestern state: a population-based study
Creators: Ingrid M Lizarraga - Department of Surgery, University of Iowa Hospitals and Clinics, 4636 JCP, 200 Hawkins Dr, Iowa City, IA, 52246, USA. ingrid-lizarraga@uiowa.edu
Amanda R Kahl - College of Public Heath, University of Iowa, Iowa, USA
Ellie Jacoby - School of Medicine, Vanderbilt University, Nashville, USA
Mary E Charlton - College of Public Heath, University of Iowa, Iowa, USA
Charles F Lynch - College of Public Heath, University of Iowa, Iowa, USA
Sonia L Sugg - Department of Surgery, University of Iowa Hospitals and Clinics, 4636 JCP, 200 Hawkins Dr, Iowa City, IA, 52246, USA
Resource Type: Journal article
Publication Details: Breast cancer research and treatment, Vol.188(1), pp.191-202
DOI: 10.1007/s10549-021-06105-x
PMID: 33582888
PMCID: PMC8238858
NLM abbreviation: Breast Cancer Res Treat
ISSN: 0167-6806
eISSN: 1573-7217
Grant note: HHSN261201800012I / NCI NIH HHS HHSN26100001 / NCI NIH HHS P30 CA086862 / NCI NIH HHS
Language: English
Date published: 02/13/2021
Academic Unit: Epidemiology; Surgery
Record Identifier: 9984214824902771

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