Relationship of Distance From a Radiotherapy Facility and Initial Breast Cancer Treatment

Substantial variation has been described in the use of breast-conserving surgery (BCS) for early-stage breast cancer (1–4) and in the receipt of radiotherapy by patients undergoing BCS (2,4–6). Increased use of BCS is associated with urban residence and with treatment in a hospital with radiotherapy available (1,3). These findings raise the question of whether the distance that a patient must travel to a radiotherapy facility affects the likelihood that BCS will be used or that the patient will receive radiotherapy in conjunction with BCS (4,5,7). According to current guidelines, women undergoing BCS should receive postoperative radiotherapy to decrease the likelihood of local disease recurrence (8). Radiotherapy is typically provided in treatments that are given 5 days per week for 5–6 weeks (9,10). To address these issues, we studied patients from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER)1 registry national public-use database, by using methods similar to those that we described previously (6). Patients from Hawaii were excluded because of the unusual geographic characteristics of this state.