Background and Aims:
The two main surgical options for women with small early breast cancer are wide local excision (WLE) with adjuvant radiotherapy, or mastectomy. The multi-disciplinary nature of WLE poses a logistical challenge in rural and remote areas, where surgical and radiotherapy centres are geographically distant. This study examined whether geographical remoteness influenced the choice of surgery for breast cancer patients in Western NSW.
Methods:
We defined small early breast cancer as Stage I-II. A retrospective cross-sectional study identified 101 women with early breast cancer presenting to a rural cancer centre in Western NSW between 2017-2019. Patients were categorised into groups based on the number of hours drive to the nearest linear accelerator. The surgical approach (WLE or mastectomy) was then analysed by group using Stata version 12.
Results:
In the cohort studied, 79 patients underwent a WLE (78.2%) and 22 patients underwent a mastectomy (21.8%). Similar proportions of women undergoing WLE were seen in those with less than 2 hours drive (79.6%) and more than 2 hours drive (76.6%) to a linear accelerator. There was a trend to decreased WLE in those with greater than 3 hours drive (60%), however no significant difference was found in surgical approach when comparing the distance categories (Pearson’s chi2 = 2.18, p=0.336).
Conclusions:
For women with early breast cancer, choosing between a WLE with adjuvant radiotherapy and mastectomy is a multi-faceted decision. This study showed that the logistical barrier of distance did not affect the surgical choices made by patients in more remote areas compared to those closer to treatment centres. A multi-centre study may be warranted in the future, to identify regions of rural Australia where additional services may be needed to ensure equity of access to treatment options.