University of North Dakota Faculty/Staff Newsletter

Medical student researchers find long travel distance related to later-stage breast cancer diagnosis

NATIONAL HARBOR, Md. — Women with breast cancer who had to travel long distances to a comprehensive cancer center

Krishan Jethwa

Krishan Jethwa

were more likely to have later-stage disease at diagnosis and a mastectomy at surgery, according to results presented at the 12th Annual American Association for Cancer Research International Conference on Frontiers in Cancer Prevention Research, held Oct. 27–30 in National Harbor, Md.

Data analysis showed an association between patients' distance from a comprehensive cancer center and stage at diagnosis, as well as an association between distance and surgery type. The longer the travel distance, the more likely women were to have later-stage disease at diagnosis, and the more likely they were to have a mastectomy.

"The main purpose of this study was to determine if women in rural North Dakota and Minnesota were at a disadvantage in terms of breast cancer screening, treatment, and ultimately, survival outcome," said Krishan Jethwa, a fourth-year medical student at the University of North Dakota School of Medicine and Health Sciences. "Travel in this part of the country can be long and difficult, especially during the winter. While investigating the public health implications of this, we found that women who live farther from a comprehensive cancer center were more likely to be diagnosed with later-stage disease. This highlights the need for improved access to screening and treatment for rural populations."

Jethwa, a native of Minot, N.D., and his colleagues—fourth-year medical students Brooke Settergren and Brittany Berg, and Associate Professor James Beal, PhD—analyzed demographic and clinical data from 260 women who were diagnosed with breast cancer between Jan. 1, 2007, and Dec. 31, 2007, and received treatment at a comprehensive cancer center in Fargo, N.D. The study investigated women aged 29 to 94 at diagnosis, with an average age of 60. All patients were white, and none had a prior cancer history.

Using the Mantel-Haenszel test for linear association, the researchers found that travel distance was related to both stage at diagnosis and surgery type. They found no association between distance and age at diagnosis, treatment with radiotherapy, or five-year survival.

Jethwa highlighted several areas for future analysis, including how much the risk of later-stage disease at diagnosis increases as a function of travel distance and whether mastectomy among rural women is linked to more advanced disease. He noted it is possible the choice of mastectomy is independent of stage at diagnosis and related to daily travel requirements. Jethwa also said that additional research on how travel distance affects the number of women receiving screening mammograms could help policymakers and health care providers devise effective interventions.

-- Karen Honey, PhD, senior managing editor of science communications with the Communications Department for the American Association for Cancer Research, was the primary author of this press release.

Contact: Denis MacLeod, assistant director, Office of Alumni and Community Relations, UND School of Medicine and Health Sciences, (701) 777-2733,