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Geographical differences in primary therapy for early-stage breast cancer
D I Gregorio1, M Kulldorff, L Barry
1Department of Community Medicine, University of Connecticut School of Medicine, Farmington 06030-6205, USA. gregorio@nso.uchc.edu
Annals of Surgical Oncology
|January 5, 2002
Summary
Geographical disparities exist in early-stage breast cancer treatment across Connecticut. Some areas show lower rates of partial mastectomy (PM) and associated treatments like axillary lymph node dissection (AND) and radiotherapy (RAD).
Area of Science:
- Oncology
- Public Health
- Surgical Outcomes
Background:
- Breast-conserving surgery, specifically partial mastectomy (PM), may not be equally accessible to all women.
- This study investigates geographical variations in the utilization of PM for early-stage breast cancer within Connecticut.
- Variations in PM combined with axillary lymph node dissection (AND) and adjuvant radiotherapy (RAD) were also examined.
Purpose of the Study:
- To evaluate geographical differences in early-stage breast cancer treatment proportions across Connecticut.
- To identify spatial variations in the rates of partial mastectomy (PM) and its common adjunct therapies (AND, RAD).
Main Methods:
- Utilized data from 9106 early-stage breast cancer cases diagnosed between 1991 and 1995 from the Connecticut Tumor Registry.
- Included 8795 records with available latitude-longitude coordinates for residence and initial therapy.
- Employed a spatial scan statistic to detect geographical variations in treatment rates statewide.
Main Results:
- Overall, 57.7% of early breast cancer cases received PM.
- Lower PM rates were observed in the New Haven area (RR=0.86), while Norwalk showed higher rates (RR=1.26).
- Geographical variations were also found for PM with AND and PM with RAD compared to PM alone across different regions.
Conclusions:
- Geographical analysis effectively identifies underserved populations regarding preferred breast cancer surgical procedures.
- Findings highlight the need for targeted interventions to address disparities in access to optimal breast cancer care.