Date of Award

1-1-2013

Document Type

Open Access Thesis

Department

Epidemiology and Biostatistics

Sub-Department

Epidemiology

First Advisor

Swann Arp Adams

Abstract

Death rates for breast cancer have steadily decreased in women due to early detection, such as mammography, and improved treatments. Despite the benefit of mammography, many women are not up-to-date on screening and do not receive timely follow-up after abnormal mammogram finding. Breast cancer is a major contributor to morbidity and mortality among women in South Carolina. To reduce the disproportionate burden of breast cancer and cervical cancer among women in South Carolina, the South Carolina Best Chance Network (BCN) was established to provide service delivery and ensures timely and complete diagnostic follow-up and treatment initiation for underserved women.

The purpose of this dissertation was to examine whether travel distance to the screening provider and mammography facility are associated with completion of abnormal mammography follow-up, breast cancer stage at diagnosis, and mortality among women in the BCN. Women enrolled in BCN between 1996 and 2009 were included in the study. Cox proportional hazard modeling was used to assess the relationship between travel distance and time to resolution. Multivariable logistic regression was used to assess the association between travel distance and breast cancer stage at diagnosis. Cox proportional hazard modeling and Kaplan-Meier survival methods were used to determine breast cancer-specific and all-cause survival probabilities.

Women who lived farther from their diagnosing mammography facility had longer day to resolution compared to those who lived the closest (p=0.05). African American women had significantly longer day to resolution compared to European American women. There was no association between travel distance to the screening provider, mammography facility and breast cancer stage at diagnosis. There was also no association between travel distance and breast cancer-specific and all-cause mortality.

Travel distance from patient's residence to the diagnosing mammography facility may have an impact on the completion of abnormal mammographic finding. However, living farther from the screening provider and mammography facility do not increase late-stage breast cancer at diagnosis and mortality among women in BCN. Support to the BCN program to expand services should be promoted to reduce the disparity in days to completion of abnormal mammographic finding. Capturing an accurate measurement of travel distance/time will help better understand whether location of the health facilities affects breast cancer outcome.

Rights

© 2013, Leepao Khang

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