This study aimed to evaluate regional disparities in surgical approaches and patient-reported outcomes (PROs) among early breast cancer patients in urban and rural areas of Nagasaki Prefecture, Japan.
Methods:
We retrospectively analyzed clinicopathological data from 1032 patients (urban: 818; rural: 214) who underwent breast cancer surgery between 2014 and 2021. PROs were assessed using the BREAST-Q survey conducted from October 2022 to June 2024 among patients; a total of 76 patients (urban n = 40; rural n = 36) completed the questionnaire.
Results:
Total mastectomy was significantly more frequent in rural facilities (66.8%) than in urban ones (49.9%). Importantly, patients undergoing breast‑conserving surgery (BCS), regardless of geographic location, reported significantly better quality‑of‑life outcomes (higher satisfaction with body image, psychological well‑being, and sexual well‑being).
Conclusion:
Geographic disparities in access to specialized surgeons and radiotherapy infrastructure may influence surgical strategies, which in turn impact PROs. These results underscore the need to address logistical barriers, surgeon availability, and rural healthcare infrastructure to ensure equitable access to BCS and improve PROs and overall quality of life.
AmatoOGuarneriVGirardiF.Epidemiology trends and progress in breast cancer survival: earlier diagnosis, new therapeutics. Curr Opin Oncol2023; 35: 612–619.
2.
CianfroccaMGradisharWJ.Controversies in the therapy of early stage breast cancer. Oncologist2005; 10: 766–779.
3.
BhatiaSLandierWPaskettED, et al. Rural-urban disparities in cancer outcomes: Opportunities for future research. J Natl Cancer Inst2022; 114: 940–952.
4.
GonzagaCMRFreitas-JuniorRSouzaMR, et al. Disparities in female breast cancer mortality rates between urban centers and rural areas of Brazil: ecological time-series study. Breast2014; 23: 180–187.
5.
EscottMYiYForetA, et al. Impact of rural location on receipt of standard of care treatment and survival for locally advanced bladder cancer in Louisiana. Cancer Med2024; 13: e7301.
6.
SeoYTakikawaT.Regional variation in national healthcare expenditure and health system performance in central cities and suburbs in Japan. Healthcare (Basel)2022; 10: 968.
7.
HaraKKunisawaSSasakiN, et al. Examining changes in the equity of physician distribution in Japan: a specialty-specific longitudinal study. BMJ Open2018; 8: e018538.
8.
FisherBAndersonSRedmondCK, et al. Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N End J Med1995; 333: 1456-1461.
9.
GiulianoAEBallmanKVMcCallL, et al. Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: The ACOSOG Z0011 (Alliance) randomized clinical trial. JAMA2017; 318: 918-926.
10.
FungKWLauYFieldingR, et al. The impact of mastectomy, breast-conserving treatment and immediate breast reconstructions on the quality of life of Chinese women. ANZ J Surg2001; 71: 202–206.
11.
ZehraSDoyleFBarryM, et al. Health-related quality of life following breast reconstruction compared to total mastectomy and breast-conserving surgery among breast cancer survivors: a systematic review and meta-analysis. Breast Cancer2020; 27: 534–566.
12.
CharltonMSchlichtingJChioresoC, et al. Challenges of rural cancer care in the United States. Oncology (Williston Park)2015; 29: 633–640.
13.
WercholukANParikhAASnyderRA.The road less traveled: Transportation barriers to cancer care delivery in the rural patient population. JCO Oncol Pract2022; 18: 652–662.
14.
SaigaMTairaNKimataY, et al. Development of a Japanese version of the BREAST-Q and the traditional psychometric test of the mastectomy module for the assessment of HRQOL and patient satisfaction following breast surgery. Breast Cancer2017; 24: 288–298.
15.
CserniGChmielikECserniB, et al. The new TNM-based staging of breast cancer. Virchows Arch2018; 472: 697–703.
16.
AllisonKHHammondMEHDowsettM, et al. Estrogen and Progesterone Receptor Testing in Breast Cancer: ASCO/CAP Guideline Update. J Clin Oncol2020; 38: 1346–1366.
17.
WolffACHammondMEHAllisonKH, et al. Human epidermal growth factor receptor 2 testing in breast cancer: American Society of Clinical Oncology/College of American Pathologists Clinical Practice Guideline Focused Update. J Clin Oncol2018; 36: 2105–2122.
18.
PusicALKlassenAFScottAM, et al. Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg2009; 124: 345–353.
19.
SchmidPCortesJPusztaiL, et al. Pembrolizumab for early triple-negative breast cancer. N Engl J Med2020; 382: 810-821.
20.
van RamshorstMSvan der VoortAvan WerkhovenED, et al. Neoadjuvant chemotherapy with or without anthracyclines in the presence of dual HER2 blockade for HER2-positive breast cancer (TRAIN-2): a multicentre, open-label, randomised, phase 3 trial. Lancet Oncol 2018; 19: 1630-1640.
21.
CardosoFO’ShaughnessyJLiuZ, et al. Pembrolizumab and chemotherapy in high-risk, early-stage, ER+/HER2- breast cancer: a randomized phase 3 trial. Nat Med2025; 31: 442-448.
22.
DuffieldJABlanchAJEstermanA, et al. The use of neoadjuvant systemic therapies in breast cancer in Australia and New Zealand: Breast Surgeons of Australia and New Zealand quality audit. ANZ J Surg2023; 93: 889-895.
23.
MiyashitaMKumamaruHNiikuraN, et al. Annual report of the Japanese Breast Cancer Registry for 2019. Breast Cancer2024; 31: 16–23.
24.
ChenRYouSYinZ, et al. Non-doctoral factors influencing the surgical choice of Chinese patients with breast cancer who were eligible for breast-conserving surgery. World J Surg Oncol2019; 17: 189.
25.
BellavanceECKesmodelSB.Decision-making in the surgical treatment of breast cancer: Factors influencing women’s choices for mastectomy and breast conserving surgery. Front Oncol2016; 6: 74.
26.
WheelerSBReeder-HayesKECareyLA.Disparities in breast cancer treatment and outcomes: biological, social, and health system determinants and opportunities for research. Oncologist2013; 18: 986–993.
27.
NgETAngRZTranBX, et al. Comparing quality of life in breast cancer patients who underwent mastectomy versus breast-conserving surgery: A meta-analysis. Int J Environ Res Public Health2019; 16: 4970.
28.
LagendijkMvan EgdomLSEvan VeenFEE, et al. Patient-reported outcome measures may add value in breast cancer surgery. Ann Surg Oncol2018; 25: 3563–3571.
29.
RobertsSAhmedS.Examination of differences in quality of life and use of support services in urban versus rural breast cancer patients. J Clin Oncol2013; 31(suppl): 98.
30.
Reid-ArndtSACoxCR.Does rurality affect quality of life following treatment for breast cancer?J Rural Health2010; 26: 402–405.
31.
MossJLMurphyJFiliaciVL, et al. Disparities in health-related quality of life in women undergoing treatment for advanced ovarian cancer: the role of individual-level and contextual social determinants. Support Care Cancer2019; 27:531–538.
