Breast Cancer Stage at Diagnosis: Is Travel Time Important?

Recent studies have produced inconsistent results in their examination of the potential association between proximity to healthcare
or mammography facilities and breast cancer stage at diagnosis. Using a multistate dataset, we re-examine this issue by investigating
whether travel time to a patient’s diagnosing facility or nearest mammography facility impacts breast cancer stage at diagnosis.
We studied 161,619 women 40 years and older diagnosed with invasive breast cancer from ten state population based cancer registries
in the United States. For each woman, we calculated travel time to their diagnosing facility and nearest mammography facility.
Logistic multilevel models of late versus early stage were fitted, and odds ratios were calculated for travel times, controlling
for age, race/ethnicity, census tract poverty, rural/urban residence, health insurance, and state random effects. Seventy-six
percent of women in the study lived less than 20 min from their diagnosing facility, and 93 percent lived less than 20 min
from the nearest mammography facility. Late stage at diagnosis was not associated with increasing travel time to diagnosing
facility or nearest mammography facility. Diagnosis age under 50, Hispanic and Non-Hispanic Black race/ethnicity, high census
tract poverty, and no health insurance were all significantly associated with late stage at diagnosis. Travel time to diagnosing
facility or nearest mammography facility was not a determinant of late stage of breast cancer at diagnosis, and better geographic
proximity did not assure more favorable stage distributions. Other factors beyond geographic proximity that can affect access
should be evaluated more closely, including facility capacity, insurance acceptance, public transportation, and travel costs.