Abstract A45: Patterns of care regarding surgical choice and application of adjuvant radiation therapy for preinvasive and early-stage breast cancer in rural Appalachia

Abstract

Abstract Objective: To conduct a cross-sectional registry analysis of women in Appalachian Kentucky with the diagnosis of early-stage breast cancer to identify factors affecting surgical choice [breast conserving surgery (BCS) versus mastectomy] and appropriate use of adjuvant radiation therapy (RT). Methods: Database collection was performed through the Kentucky Cancer Registry. Inclusion criteria included female breast cancer patients diagnosed between 1998 and 2007. All patients were ≥ 20 years of age diagnosed with DCIS or AJCC stage I or II disease as a first primary diagnosis. Database search was limited to Appalachian residents and were stratified by Beale codes 1-3 for urban locales and 4-9 for rural. Statistics including univariate, multivariate, and Cox survival analyses were performed to identify factors affecting surgical choice, receipt of RT and variables relating to survival. Results: Analysis was based on 5541 evaluable Appalachian patients, of whom 86.2% lived in a rural location and 13.8% were urban. The overall distribution of primary surgery slightly favored BCS (54.1 %) over mastectomy (45.9%). On multivariate analysis, the most significant factors for mastectomy as the initial surgical procedure were advanced stage (OR 2.571, P<0.0001), rural location (OR 2.075, p<0.0001), and insurance status (OR 1.546, p<0.0001). Of patients choosing BCS, 56.2% received adjuvant RT. On multivariate analysis age >70 (OR 2.506, p<0.0001), rural location (OR 2.416, p<0.0001), and lack of insurance (OR 1.651, p=0.0168) were the strongest predictors for not receiving adjuvant RT. Cox survival analysis correlated with receipt of RT after BCS, ER/PR status, age, smoking history, insurance status, stage, and tumor size. Conclusions: The rate of mastectomy remains higher and the rate of RT after BCS is significantly lower in Appalachian women compared to other contemporary studies of women with preinvasive and early stage breast cancer. Within the Appalachian population, these disparities are most apparent among rural and uninsured women. Further studies are needed to advance awareness of and access to health care initiatives to improve quality of breast cancer care for the underserved. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A45.