Rural-urban variation in breast-conserving surgery in Kentucky

Recently researchers from the University of Kentucky published a study showing that, in the early 1990s, Appalachian women were less likely to receive breast-conserving surgery (BCS) in the treatment of early stage cancer, than other Kentucky women diagnosed with early stage breast cancer, and that poverty was the only predictor of lowered probability of receiving BCS. In that study, analyses were performed on a dataset of Kentucky Medicare beneficiary claims of treatment information that had been linked with data from the Kentucky Cancer Registry for staging information. County-level data were also used, from the 1990 census and other sources, on poverty and education rates for women, and hospital bed and physician ratios per population. While the findings of the study are significant, the study is generalizable only to women aged 65 years and older because a Medicare dataset was used. In addition, the study represented Kentucky practice seven to ten years ago, from 1992 through 1995, which raises interest in obtaining BCS rates for more current practice. In this article, we update the previous study with the most recent data on BCS, and include women of all ages, not just those over age 64 years. Access was obtained to the Kentucky Cancer Registry, which contains records of the initial treatment for breast cancer, as well as staging information about the extent of disease at diagnosis. Data from the 2000 census were not available for this analysis, however.