Rural-urban differences in radiation therapy for ductal carcinoma in-situ of the breast

Purpose. Rural women in the United States are at a documented disadvantage with regard to breast cancer detection, diagnosis, and treatment and genera lly do not receive state-of-the-art therapy. The objective of the study was to determine if, and to what extent, rural women were less likely to recei ve radiation therapy (XRT) following breast conserving surgery (BCS) for du ctal carcinoma in-situ (DCIS). Methods. Our analyses were based on 1991-1996 data provided by the Surveill ance, Epidemiology, and End Results (SEER) Program. Only women who were dia gnosed with their first primary, microscopically confirmed DCIS breast canc er were included. BCS and XRT were defined according to SEER definitions. M ultiple logistic regression was used in the analysis. Results. During this time period, 6,988 women were treated with BCS for DCI S, 50.1% of whom received XRT. In multivariate analysis, rural women in gen eral (OR = 0.58) and younger women (< 65) in particular (OR = 0.38) were le ss likely to receive XRT. Local availability of XRT was not associated with receipt among younger women, while older women without this availability w ere less likely to receive XRT (OR = 0.48). Conclusions. Barriers to XRT following BCS for DCIS may be different betwee n younger and older rural women relative to their urban counterparts.