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. 2025 Sep:247:116484.
doi: 10.1016/j.amjsurg.2025.116484. Epub 2025 Jun 16.

Association between travel burden and surgical timeliness for women with breast cancer in Georgia

Nicole Rademacher  1 , M Chandler McLeod  2 , Courtney P Williams  3 , Sofia Awan  4 , Katherine E McElroy  5 , Geetanjali Saini  6 , Keerthi Gogineni  7 , Justin M Luningham  8 , Ritu Aneja  9 , Lily A Gutnik  10
Affiliations

Association between travel burden and surgical timeliness for women with breast cancer in Georgia

Nicole Rademacher et al. Am J Surg. 2025 Sep.

Abstract

Introduction: This study evaluates associations between patient distance traveled to surgical care and receipt of timely breast cancer surgery in Georgia.

Methods: This retrospective cohort study included electronic health record data from women diagnosed with stage I-III breast cancer from 2004 to 2020 who received upfront surgery. Race was self-reported. Distance from patient home address to surgical treatment facility was measured as crow-fly distance. Multivariable logistic regression models estimated associations between time to surgery, race, and distance.

Results: Of 18,240 patients (White ​= ​61 ​% and Black ​= ​39 ​%) with a median distance to surgery of 11.4 miles (IQR: 5.9, 19.6), Black patients had approximately half the odds of receiving surgery within the recommended 60 days of diagnosis (OR: 0.52, 95 ​% CI: 0.47-0.56). Distance traveled was not associated with time to surgery.

Conclusion: Understanding mechanisms driving surgical care delays and their effects on breast cancer outcomes is critical to reducing inequities in breast cancer care.

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Conflict of interest statement

Declaration of competing interest This study was approved by the Georgia State University Institutional Review Board (IRB) and by the hospitals providing data. The IRB waived the need for consent as medical record data were collected retrospectively. This research did not receive any specific grants from funding agencies in the public, commercial, or not-for-profit sectors. Dr. Rademacher receives support from the Agency for Healthcare Research and Quality (T32 HS013852). Dr. Williams receives support from a National Cancer Institute Mentored Research Scientist Development Award (K01CA296932-01). Dr. McElroy received support from a National Institute of Health Grant (T32 CA229102). Dr. Gogineni receives funding from Calithera, Merck, Genentech, SeaGen, Metaclipse, DOD. The authors have no relevant financial or other conflicts of interest related to the conduct of this work. Dr. Williams discloses research funding from Flatiron Health. Dr. Gogineni serves in an advisory role to Pfizer and receives honoraria from AmerisourceBergen.

Figures

Figure 1.
Figure 1.
Study cohort exclusion cascade
Figure 2.
Figure 2.
Kaplan Meier curve of time to surgery by race.
Figure 3.
Figure 3.
Kaplan Meier curve of time to surgery by distance to surgery.
See this image and copyright information in PMC

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