The study: Researchers at Johns Hopkins University analyzed data from 80,000 patient records available in the 2006 U.S. Surveillance, Epidemiology, and End Results (SEER) database and the 2004 Area Resource File to determine whether there were differences in radiation therapy use between women who live in urban or rural areas. Previous studies have shown that women in rural areas are more likely to choose mastectomy (removal of the breast as a treatment for breast cancer) over lumpectomy than women in urban areas. This finding has often been attributed to lack of access to radiation therapy in rural areas. This study is the first to compare the use of radiation therapy after lumpectomy and mastectomy between women in rural or urban areas to determine if access to radiation therapy could be affecting a woman's choice of treatment.

The results: The rates of radiation therapy after lumpectomy or mastectomy were not different based on whether a woman lives in a rural or urban area. Among the women who had a lumpectomy, 81% of urban women and 80% of rural women received radiation therapy after surgery. Among women who had a mastectomy, 39% of urban women and 38% of rural women received radiation therapy. Although the percentage of women receiving radiation therapy after surgery was similar, rural women were more likely to choose mastectomy instead of lumpectomy. About 60% of rural women chose a mastectomy compared with about 45% of urban women.

What this means for patients

“We thought access to radiation therapy was influencing rural women to choose mastectomy over lumpectomy with follow-up radiation, but our findings show this is not the case,” said lead author Lisa K. Jacobs, MD, Assistant Professor of Surgery at Johns Hopkins University in Baltimore, Maryland. “Since these findings show access to radiation therapy does not impact a woman's decision about which type of surgery to have for breast cancer, we will need to look at other factors, such as quality of patient education about treatment options.” Talk with your doctor about all your treatment options. The best treatment for you may be different than the best treatment for another woman with breast cancer.

What to Ask Your Doctor About Lumpectomy and Radiation Therapy

• Would you explain my surgical treatment options to me?
• Am I a candidate for lumpectomy, or do I need a mastectomy?
• Will I receive radiation therapy after surgery?
• Will you describe what I will experience when I receive radiation therapy? Will it hurt or cause me discomfort during the treatment?
• What are the possible short term and long term side effects of each treatment?