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Impact of age, rurality and distance in predicting contralateral prophylactic mastectomy for breast cancer in a Midwestern state: a population-based study

  • Epidemiology
  • Published:
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Abstract

Purpose

Iowa is among several rural Midwestern states with the highest proportions of contralateral prophylactic mastectomy (CPM) in women < 45 years of age. We evaluated the role of rurality and travel distance in these surgical patterns.

Methods

Women with unilateral breast cancer (2007–2017) were identified using Iowa Cancer Registry records. Patients and treating hospitals were classified as metro, nonmetro, and rural based on Rural–Urban Continuum Codes. Differences in patient, tumor, and treatment characteristics and median travel distance (MTD) were compared. Characteristics associated with CPM were evaluated with multivariate logistic regression.

Results

22,158 women were identified: 57% metro, 26% nonmetro and 18% rural. Young rural women had the highest proportion of CPM (52%, 39% and 40% for rural, metro, nonmetro women < 40 years). Half of all rural women had surgery at metro hospitals; these women had the longest MTD (62 miles). Among all women treated at metro hospitals, rural women had the highest proportion of CPM (17% rural vs 14% metro/nonmetro, p = 0.007). On multivariate analysis, traveling ≥ 50 miles (ORs 1.43–2.34) and rural residence (OR = 1.29) were independently predictive of CPM. Other risk factors were young age (< 40 years: OR = 7.28, 95% CI 5.97–8.88) and surgery at a metro hospital that offers reconstruction (OR = 2.30, 95% CI 1.65-3.21) and is not NCI-designated (OR = 2.34, 95% CI 1.92–2.86).

Conclusion

There is an unexpectedly high proportion of CPM in young rural women in Iowa, and travel distance and availability of reconstructive services likely influence decision-making. Improving access to multidisciplinary care in rural states may help optimize decision-making.

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Data availability

Cases were extracted from the Iowa Cancer Registry Surveillance, Epidemiology, and End Results (SEER) Data Management System (SEER*DMS). The datasets generated and/or analyzed during the current study are not publicly available because they contain protected health information of patients, as well as specific names of hospitals. A de-identified version of our analytic dataset could be available from the corresponding author upon reasonable request.

Abbreviations

CPM:

Contralateral prophylactic mastectomy

UM:

Unilateral mastectomy

MTD:

Median travel distance

SEER:

Surveillance, epidemiology, and end results

CoC:

Commission on cancer

NCDB:

National cancer database

RUCC:

Rural–urban continuum codes

References

  1. Wong SM, Freedman RA, Sagara Y, Aydogan F, Barry WT, Golshan M (2017) Growing use of contralateral prophylactic mastectomy despite no improvement in long-term survival for invasive breast cancer. Ann Surg 265:581–9

    Article  Google Scholar 

  2. Pesce C, Liederbach E, Wang C, Lapin B, Winchester DJ, Yao K (2014) Contralateral prophylactic mastectomy provides no survival benefit in young women with estrogen receptor-negative breast cancer. Ann Surg Oncol 21:3231–9

    Article  Google Scholar 

  3. Boughey JC, Attai DJ, Chen SL, Cody HS, Dietz JR, Feldman SM, Greenberg CC, Kass RB, Landercasper J, Lemaine V et al (2016) Contralateral Prophylactic Mastectomy (CPM) Consensus Statement from the American Society of Breast Surgeons: Data on CPM Outcomes and Risks. Ann Surg Oncol 23:3100–5

    Article  Google Scholar 

  4. Hunt KK, Euhus DM, Boughey JC, Chagpar AB, Feldman SM, Hansen NM, Kulkarni SA, McCready DR, Mamounas EP, Wilke LG, Van Zee KJ, Morrow M (2017) Society of surgical oncology breast disease working group statement on prophylactic (risk-reducing) mastectomy. Ann Surg Oncol 24:375–97. https://doi.org/10.1245/s10434-016-5688-z

    Article  PubMed  Google Scholar 

  5. Wright FC, Look Hong NJ, Quan ML, Beyfuss K, Temple S, Covelli A, Baxter N, Gagliardi AR (2018) Indications for contralateral prophylactic mastectomy: a consensus statement using modified delphi methodology. Ann Surg 267:271–9

    Article  Google Scholar 

  6. Grimmer L, Liederbach E, Velasco J, Pesce C, Wang CH, Yao K (2015) Variation in contralateral prophylactic mastectomy rates according to racial groups in young women with breast cancer, 1998 to 2011: a report from the national cancer data base. J Am Coll Surg 221:187–196

    Article  Google Scholar 

  7. Jerome-D’Emilia B, Trinh H (2020) Socioeconomic factors associated with the receipt of contralateral prophylactic mastectomy in women with breast cancer. J Womens Health (Larchmt) 29:220–229. https://doi.org/10.1089/jwh.2018.7350 (Epub 2019 Feb 13 PMID: 30759049)

    Article  Google Scholar 

  8. Jagsi R, Hawley ST, Griffith KA, Janz NK, Kurian AW, Ward KC, Hamilton AS, Morrow M, Katz SJ (2017) Contralateral prophylactic mastectomy decisions in a population-based sample of patients with early-stage breast cancer. JAMA Surg 152:274–282. https://doi.org/10.1001/jamasurg.2016.4749.PMID:28002555;PMCID:PMC5531287

    Article  PubMed  PubMed Central  Google Scholar 

  9. Ward EP, Unkart JT, Bryant A, Murphy J, Blair SL (2017) Influence of distance to hospital and insurance status on the rates of contralateral prophylactic mastectomy, a national cancer data base study. Ann Surg Oncol 24:3038–47

    Article  Google Scholar 

  10. Obeng-Gyasi S, Timsina L, Bhattacharyya O, Fisher CS, Haggstrom DA (2020) Breast cancer presentation, surgical management and mortality across the rural-urban continuum in the national cancer database. Ann Surg Oncol 27:1805–15

    Article  Google Scholar 

  11. Nash R, Goodman M, Lin CC, Freedman RA, Dominici LS, Ward K, Jemal A (2017) State variation in the receipt of a contralateral prophylactic mastectomy among women who received a diagnosis of invasive unilateral early-stage breast cancer in the United States, 2004–2012. JAMA Surg 152:648–57

    Article  Google Scholar 

  12. Meit M, Knudson A, Gilbert T, et al (2014) The 2014 Update of the Rural-Urban Chartbook. Bethesda, MD: Rural Health Reform Policy Research Center Web site. https://ruralhealth.und.edu/projects/health-reform-policy-research-center/pdf/2014-rural-urban-chartbook-update.pdf. Accessed 3 Nov 2020

  13. Weaver KE, Palmer N, Lu L, Case LD, Geiger AM (2013) Rural-urban differences in health behaviors and implications for health status among US cancer survivors. Cancer Causes Control 24:1481–90

    Article  Google Scholar 

  14. Iglehart JK (2018) The challenging quest to improve rural health care. N Engl J Med 378:473–9

    Article  Google Scholar 

  15. Henley SJ, Anderson RN, Thomas CC, Massetti GM, Peaker B, Richardson LC (2017) Invasive cancer incidence, 2004–2013, and deaths, 2006–2015, in nonmetropolitan and metropolitan counties - United States. MMWR Surveill Summ 66:1–13

    Article  Google Scholar 

  16. Lin CC, Bruinooge SS, Kirkwood MK, Olsen C, Jemal A, Bajorin D, Giordano SH, Goldstein M, Guadagnolo BA, Kosty M et al (2015) Association between geographic access to cancer care, insurance, and receipt of chemotherapy: geographic distribution of oncologists and travel distance. J Clin Oncol 33:3177–85

    Article  Google Scholar 

  17. Lin Y, Wimberly MC, Da Rosa P, Hoover J, Athas WF (2018) Geographic access to radiation therapy facilities and disparities of early-stage breast cancer treatment. Geospat Health 13:622

    Article  Google Scholar 

  18. Polacek GN, Ramos MC, Ferrer RL (2007) Breast cancer disparities and decision-making among U.S. women. Patient Educ Couns 65:158–165

    Article  Google Scholar 

  19. Meden T, St John-Larkin C, Hermes D, Sommerschield S (2002) Relationship between travel distance and utilization of breast cancer treatment in rural northern Michigan. JAMA 287:111

    Article  Google Scholar 

  20. Goyal S, Chandwani S, Haffty BG, Demissie K (2015) Effect of travel distance and time to radiotherapy on likelihood of receiving mastectomy. Ann Surg Oncol 22:1095–1101

    Article  Google Scholar 

  21. Freedman RA, Virgo KS, He Y, Pavluck AL, Winer EP, Ward EM, Keating NL (2011) The association of race/ethnicity, insurance status, and socioeconomic factors with breast cancer care. Cancer 117:180–9. https://doi.org/10.1002/cncr.25542

    Article  PubMed  Google Scholar 

  22. U.S. Census Bureau: 2012-2016 American Community Survey 5-Year Estimates. https://www.census.gov/programs-surveys/acs/technical-documentation/table-and-geography-changes/2016/5-year.html. Accessed 3 Nov 2020.

  23. United States Department of Agriculture Rural-Urban Continuum Codes (2016) https://www.ers.usda.gov/data-products/rural-urban-continuum-codes/. Accessed 3 Nov 2020.

  24. Bennett T, Skatrud JD, Guild P, Loda F, Klerman LV (1997) Rural adolescent pregnancy: a view from the South. Fam Plann Perspect 29(256–260):267

    Google Scholar 

  25. SEER Program Coding and Staging Manual 2016: Surgery Codes Breast. [https://seer.cancer.gov/archive/manuals/2016/AppendixC/Surgery_Codes_Breast_2016.pdf]. Accessed 3 Nov 2020.

  26. Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence - SEER Research Plus Data, 18 Registries, Nov 2019 Sub (2000-2017) - Linked To County Attributes - Total U.S., 1969-2018 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, released April 2020, based on the November 2019 submission. Accessed 3 Nov 2020.

  27. 2002–2020 Rural Health Infortmation Hub. https://www.ruralhealthinfo.org/data-explorer?id=185&classification=Nonmetropolitan. Accessed 3 Nov 2020.

  28. Ward MM, Ullrich F, Matthews K, Rushton G, Tracy R, Goldstein MA, Bajorin DF, Kosty MP, Bruinooge SS, Hanley A, Jacobson GM, Lynch CF (2014) Where do patients with cancer in Iowa receive radiation therapy? J Oncol Pract 10:20–25

    Article  Google Scholar 

  29. Albornoz CR, Cohen WA, Razdan SN, Mehrara BJ, McCarthy CM, Disa JJ, Dayan JH, Pusic AL, Cordeiro PG, Matros E (2016) The impact of travel distance on breast reconstruction in the United States. Plast Reconstr Surg 137:12–18

    Article  CAS  Google Scholar 

  30. Rosenberg SM, Sepucha K, Ruddy KJ, Tamimi RM, Gelber S, Meyer ME, Schapira L, Come SE, Borges VF, Golshan M, Winer EP, Partridge AH (2015) Local therapy decision-making and contralateral prophylactic mastectomy in young women with early-stage breast cancer. Ann Surg Oncol 22:3809–15

    Article  Google Scholar 

  31. Bellavance E, Peppercorn J, Kronsberg S, Greenup R, Keune J, Lynch J, Collyar D, Magder L, Tilburt J, Hlubocky F et al (2016) Surgeons’ perspectives of contralateral prophylactic mastectomy. Ann Surg Oncol 23:2779–87. https://doi.org/10.1245/s10434-015-4572-6

    Article  PubMed  Google Scholar 

  32. Baptiste DF, MacGeorge EL, Venetis MK, Mouton A, Friley LB, Pastor R, Hatten K, Lagoo J, Clare SE, Bowling MW (2017) Motivations for contralateral prophylactic mastectomy as a function of socioeconomic status. BMC Womens Health 17:10

    Article  Google Scholar 

  33. Bauder AR, Gross CP, Killelea BK, Butler PD, Kovach SJ, Fox JP (2017) The relationship between geographic access to plastic surgeons and breast reconstruction rates among women undergoing mastectomy for cancer. Ann Plast Surg 78:324–329. https://doi.org/10.1097/SAP.0000000000000849 (PMID: 28177978)

    Article  CAS  PubMed  Google Scholar 

  34. Anderson SR, Sieffert MR, Talarczyk CMR, Johnson RM, Fox MJP (2019) Geographic variation in breast reconstruction modality use among women undergoing mastectomy. Ann Plast Surg 82:382–385. https://doi.org/10.1097/SAP.0000000000001746 (PMID: 30633025)

    Article  CAS  PubMed  Google Scholar 

  35. Birkmeyer JD, Reames BN, McCulloch P, Carr AJ, Campbell WB, Wennberg JE (2013) Understanding of regional variation in the use of surgery. Lancet 382:1121–1129

    Article  Google Scholar 

  36. Katz SJ, Hawley ST, Hamilton AS, Ward KC, Morrow M, Jagsi R, Hofer TP (2018) Surgeon influence on variation in receipt of contralateral prophylactic mastectomy for women with breast cancer. JAMA Surg 153:29–36. https://doi.org/10.1001/jamasurg.2017.3415.PMID:28903158;PMCID:PMC5833615

    Article  PubMed  Google Scholar 

  37. Roberts A, Habibi M, Frick K (2014) Cost-effectiveness of contralateral prophylactic mastectomy for prevention of contralateral breast cancer. Ann Surg Oncol 21:2209–17. https://doi.org/10.1245/s10434-014-3588-7

    Article  PubMed  Google Scholar 

  38. Knutson AC, McNamara EJ, McKellar DP, Kaufman CS, Winchester DP (2014) The role of the American College of Surgeons’ cancer program accreditation in influencing oncologic outcomes. J Surg Oncol 110:611–5. https://doi.org/10.1002/jso.23680 (Epub 2014 Jul 8 PMID: 25042831)

    Article  PubMed  Google Scholar 

  39. Black P. Wisconsin Divided Six Ways: A Review of Rural-Urban Classification Systems (2016) [http://worh.org/sites/default/files/Wisconsin%20Divided%20Six%20Ways_1.pdf]. Accessed 3 Nov 2020.

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Funding

This work was supported by the National Cancer Institute at the National Institutes of Health (Grant Numbers HHSN261201800012I/ HHSN26100001 to CFL, MEC, ARK; P30 CA086862 to MEC, ARK).

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Authors and Affiliations

  1. Department of Surgery, University of Iowa Hospitals and Clinics, 4636 JCP, 200 Hawkins Dr, Iowa City, IA, 52246, USA

    Ingrid M. Lizarraga & Sonia L. Sugg

  2. College of Public Heath, University of Iowa, Iowa, USA

    Amanda R. Kahl, Mary E. Charlton & Charles F. Lynch

  3. School of Medicine, Vanderbilt University, Nashville, USA

    Ellie Jacoby

Authors
  1. Ingrid M. Lizarraga
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  2. Amanda R. Kahl
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  6. Sonia L. Sugg
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Contributions

AK performed primary data analysis and prepared the methods section, tables and figures. EJ assisted in the primary data analysis, literature review and preparation of the manuscript. MC and CL provided expertise in the datasets used, directed the statistical analysis and contributed to the writing of the manuscript. IL and SS were involved in developing study design. IL was the primary manuscript author and SS was a major contributor in writing the manuscript. All authors read, edited and approved the final manuscript.

Corresponding author

Correspondence to Ingrid M. Lizarraga.

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None of the authors have any financial or nonfinancial conflict of interest.

Ethical approval

This study was granted human subject exemption status by the University of Iowa Institutional Review Board.

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Lizarraga, I.M., Kahl, A.R., Jacoby, E. et al. Impact of age, rurality and distance in predicting contralateral prophylactic mastectomy for breast cancer in a Midwestern state: a population-based study. Breast Cancer Res Treat 188, 191–202 (2021). https://doi.org/10.1007/s10549-021-06105-x

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