Abstract
Background and Aims: Longer travel time to health care services has been shown to be associated with more advanced stage at diagnosis and differences in surgical care for women with breast cancer. The influence of travel time on other disease characteristics at diagnosis and on use of other breast cancer treatments is not known. We examined travel time in relation to stage, nodal involvement, tumor size, primary and adjuvant treatments, and receipt of surveillance mammography to provide a more detailed examination of the role of travel time in access and utilization of breast cancer services to help further understand barriers to recommended care. Methods: Using an established cohort of women enrolled at Group Health, with an early stage breast cancer diagnosis from 1990–1999 (N=1306), we linked travel time estimates with tumor and treatment data. Travel time was estimated for each census block in Washington to the nearest radiology facility and was then attributed to women based on geocoded residence data. Tumor and treatment data were abstracted from chart review and from SEER data. We modeled bivariate relations between travel time and outcomes using log binomial generalized linear regression (glm). Results: Most women (90%) lived within 30 minutes of the nearest radiology facility. Travel time >45 min. was associated with a greater likelihood of mastectomy vs. breast conserving surgery (Referent group:travel time <10min: RR=1.48; 95%CI:1.03–2.13) and with use of adjuvant chemotherapy (RR=1.65; 95% CI:1.01–2.70). Travel time did not significantly influence stage at diagnosis, tumor size, radiation treatment, or receipt of surveillance mammography in the first two years following cancer treatment. Conclusions: In the Group Health population, travel time appears to differentially influence patterns of care for women with early stage breast cancer and does not appear to be related to tumor characteristics at diagnosis.