Journal article
Rural-urban differences in secular trends of locoregional treatment for ductal carcinoma in situ: A patterns of care analysis
Cancer medicine, Vol.11(11), pp.2284-2295
02/11/2022
DOI: 10.1002/cam4.4605
PMCID: PMC9160801
PMID: 35146946
Abstract
Omission of PORT following BCS remains high among rural patients despite evidence that PORT leads to a significant reduction in the risk of local recurrence. Further research is needed to examine the impact of rural residence on treatment choices and develop methods to ensure equitable care among all breast cancer patients.
Despite national guidelines, debate exists among clinicians regarding the optimal approach to treatment for patients diagnosed with ductal carcinoma in situ (DCIS). While regional variation in practice patterns has been well documented, population-based information on rural-urban treatment differences is lacking.
Data from the SEER Patterns of Care studies were used to identify women diagnosed with histologically confirmed DCIS who underwent cancer-directed surgery in the years 1991, 1995, 2000, 2005, 2010, and 2015. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using weighted multivariable logistic regression to evaluate cancer-directed surgery and use of post-operative radiation therapy (PORT).
Of the 3337 patients who met inclusion criteria, 27% underwent mastectomy, 26% underwent breast-conserving surgery (BCS) without PORT, and 47% underwent BCS with PORT. After adjustment for other covariates, there was no difference in the likelihood of receiving mastectomy between rural and urban patients (aOR = 0.65; 95% CI 0.37-1.14). However, rural residents were more likely than urban residents to have mastectomy during 1991/1995 (aOR = 1.78; 95% CI 1.09-2.91; p
= 0.022). Across all diagnosis years, patients residing in rural areas were less likely to receive PORT following BCS compared to urban patients (aOR = 0.35; 95% CI 0.18-0.67).
Omission of PORT following BCS remains high among rural patients despite evidence that PORT leads to a significant reduction in the risk of local recurrence. Further research is needed to examine the impact of rural residence on treatment choices and develop methods to ensure equitable care among all breast cancer patients.
Details
- Title: Subtitle
- Rural-urban differences in secular trends of locoregional treatment for ductal carcinoma in situ: A patterns of care analysis
- Creators
- Danielle Riley - Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USAElizabeth A Chrischilles - Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USAIngrid M Lizarraga - Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USAMary Charlton - Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USABrian J Smith - Holden Comprehensive Cancer Center, University of Iowa, Iowa, USACharles F Lynch - Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USA
- Resource Type
- Journal article
- Publication Details
- Cancer medicine, Vol.11(11), pp.2284-2295
- DOI
- 10.1002/cam4.4605
- PMID
- 35146946
- PMCID
- PMC9160801
- NLM abbreviation
- Cancer Med
- ISSN
- 2045-7634
- Grant note
- N01-PC-67008 / NCI NIH HHS HHSN261201000032C / NCI NIH HHS HHSN261201300020I / NCI NIH HHS P30 CA086862 / NCI NIH HHS N01-CN-05229 / NCI NIH HHS N01-PC-35143 / NCI NIH HHS
- Language
- English
- Date published
- 02/11/2022
- Academic Unit
- Pharmacy; Epidemiology; Biostatistics; Surgery; Holden Comprehensive Cancer Center
- Record Identifier
- 9984216741702771
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