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SAN FRANCISCO – A distance of just five miles can influence whether a breast cancer patient chooses to have a mastectomy or breast-conserving surgery followed by radiation therapy, according to a study at Durham Regional Hospital, a 391-bed community hospital that is part of Duke University Health System.

Both treatments have been shown to be equally effective in the vast majority of breast cancer patients. But women often choose the more radical surgical approach of mastectomy if it means they do not have to travel to a separate facility for six weeks of daily radiation treatments, said Dr. Carol Hahn, lead author of the study. The less invasive "lumpectomy" surgery followed by radiation is called breast-conserving therapy (BCT).

Hahn, a radiation oncologist at Duke University Medical Center and the chief of the division of radiation oncology at Durham Regional Hospital, prepared her findings for the annual meeting of the American Society for Therapeutic Radiology and Oncology Nov. 5–11.

Hahn said her results indicate that patients may look beyond the pure medical benefits and select a treatment based largely on psychological and logistical factors, like distance to daily treatments, comfort level with the facility, fear of radiation, exposure to a particular viewpoint and doctor/patient biases.

"Something as minor as a five-mile distance seems inconsequential when you are dealing with an overwhelming issue like breast cancer," said Hahn. "But the very fact that you are feeling overwhelmed can make seemingly insignificant factors feel like the last straw on the camel's back."

Hahn embarked on her study after noticing that more women were choosing breast conserving therapy after Duke University Health System opened a new radiation therapy clinic at Durham Regional Hospital in 1996. With the new clinic, patients could receive their lumpectomy in one area of Durham Regional and then return for daily radiation therapy in another area of the hospital, rather than traveling five miles away to Duke University Hospital to meet with a radiation oncologist and receive their radiation.

This seemingly minor shift in the radiation clinic location created a dramatic change in which procedure women began to choose, said Hahn. During the two years before the clinic opened at Durham Regional, 71.3 percent of women there opted for mastectomy and only 28.7 percent opted for breast conserving therapy. During the two years after the clinic opened at Durham Regional Hospital, 56.3 percent of patients chose mastectomy and 43.7 percent chose breast-conserving therapy. This difference was highly statistically significant, said Hahn. The data were derived from pathology reports on women's diagnoses and treatment choices.

There were no known changes in the staffing or patient population during the study period, said Hahn. The Duke radiation oncologists had simply moved from seeing and treating these patients at Duke to the new clinic at Durham Regional. The surgeons at Durham Regional Hospital had remained the same, and the patient population and demographic profiles were unchanged, as well.

Hahn said many factors could account for why more women began to opt for breast conserving therapy in the new clinic. First, accessibility and familiarity drive many women to choose treatment within their neighborhoods. Older women and those with less money or resources often have transportation or child-care constraints that prohibit daily commutes to treatment. Parking hassles and wait times tend to be lower at community facilities. And many women are simply more comfortable in a familiar, community setting. Second, having a group of radiation oncologists on site, working in concert with the surgeons who make the cancer diagnosis, exposes women to a broader range of opinions and viewpoints from which to chose, said Hahn.

Additionally, surgeons are the front-line communicators, explaining the various options to women after their biopsies come back positive for cancer. Surgeons can now send patients over to the clinic for an in-depth consultation or tour instead of just mentioning breast-conserving therapy as an option.

As the surgeons begin to see a greater volume of their patients undergoing breast-conserving therapy with good results, they are more comfortable presenting this option to new patients in the future, she added.

Moreover, Hahn said, most women tolerate breast radiotherapy extremely well with minimal side effects and excellent treatment results, both from a curative and a cosmetic standpoint.