Differences in early stage breast cancer treatment decisions for rural and urban women

Background: Women diagnosed with early stage breast cancer (ESBC) face numerous treatment decisions, especially the primary type of surgical treatment. The availability of different, yet similarly effectiv, treatments in terms of mortality, means that the decision about treatment of ESBC is potentially influenced by multiple factors, making patient-centered decision making vitally important. There are known geographic differences in the number of women who choose different surgical treatment options. Method: The purpose of this mixed-methods study was to explore differences in ESBC treatment decision-making for rural and urban women. Stokol's Social Ecological Framework and Janis and Mann's Decision-Making Theory guided this study. Surveys were mailed to women diagnosed with ESBC over a five year prior. There were 1,093 of 2,449 returned (44.6% response). Seven focus groups were held in rural and urban settings. Results: Women from small vs. large rural areas were more likely to choose mastectomy (p = .02). Insurance coverage, cost and distance to treatment were significantly more important in treatment decisions for women from small rural areas. Focus group findings highlighted the roles of health care providers, fear of recurrence, and personal choice in treatment decisions. Conclusions: Differences in ESBC treatment decsions exist for rural and non-rural women. Public health providers should assure access to comprehensive breast care for all women.