Breast cancer stage at diagnosis: is travel time important?

J Community Health. 2011 Dec;36(6):933-42. doi: 10.1007/s10900-011-9392-4.


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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Breast Neoplasms / diagnosis
  • Breast Neoplasms / epidemiology
  • Breast Neoplasms / pathology*
  • Delayed Diagnosis / statistics & numerical data
  • Female
  • Health Services Accessibility / economics
  • Health Services Accessibility / statistics & numerical data*
  • Health Status Disparities
  • Humans
  • Insurance Coverage / economics
  • Insurance Coverage / statistics & numerical data
  • Insurance, Health / economics
  • Insurance, Health / statistics & numerical data*
  • Logistic Models
  • Mammography / economics
  • Mammography / statistics & numerical data*
  • Middle Aged
  • Neoplasm Staging
  • Poverty
  • Registries
  • Time Factors
  • Travel / economics
  • Travel / statistics & numerical data
  • United States / epidemiology