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Erschienen in:
23.03.2020 | Health Services Research and Global Oncology
Breast Cancer Presentation, Surgical Management and Mortality Across the Rural–Urban Continuum in the National Cancer Database
Erschienen in: Annals of Surgical Oncology | Ausgabe 6/2020
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Objective
The purpose of this study was to examine differences in presentation, surgical management, and mortality among breast cancer patients in the National Cancer Database (NCDB) based on area of residence.
Methods
The NCDB was queried for women with a diagnosis of breast cancer from 1 January 2004–31 December 2015. The data were divided by metropolitan (large, medium, small) and non-metropolitan (urban, rural) status.
Results
Cancer stage increased with rurality (p < 0.0001). Residency in a large metropolitan area was associated with increased breast reconstruction rates (odds ratio [OR] 1.25, 95% confidence interval [CI] 1.19–1.30) and reduced overall mortality (hazard ratio 0.92, 95% CI 0.89–0.95) compared with rural areas. There was no difference in mastectomy use among small metropolitan (OR 1.03, 95% CI 1.01–1.04), urban (OR 0.99, 95% CI 0.98–1), and rural areas (OR 1.05, 95% CI 1.01–1.07) compared with large metropolitan areas.
Conclusions
Across the rural–urban continuum in the NCDB, stage of cancer presentation increased with rurality. Conversely, residency in a large metropolitan area was associated with higher reconstruction rates and a reduction in overall mortality. Future studies should evaluate factors contributing to advanced disease presentation and lower reconstruction rates among rural breast cancer patients.