ArticleAnnals of surgery2026
The Effect of Rurality on Time to Surgery and Overall Survival Among Women With Breast Cancer.
Article in Annals of surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
2 citing papers in PubMed.
- Rural Residence and Postsurgical Outcomes Among Medicare Beneficiaries.JAMA network open · 2026Article
- The rural-urban paradox: rethinking delays in breast cancer care.Gland surgery · 2026Article
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13 authors.
Funding
Abstract
objectiveHow does distance to care affect time to surgery (TTS) and overall survival (OS) among rural patients with breast cancer? SUMMARY BACKGROUND DATA: TTS >60 days is associated with known sociodemographic characteristics and worse OS after breast cancer diagnosis, but the relationship between rurality, proximity to care, TTS, and OS remains unknown.
methodsWe identified females who are 18 years and above with stage 0-III breast cancer diagnosed between 2004 and 2019 who received upfront surgery in the National Cancer Database. Mediation and Cox proportional hazards analyses were conducted to assess the relationship between rurality, distance to treatment facility, prolonged TTS (ie, >60 days), and OS.
resultsOf 1,979,194 patients meeting inclusion criteria, 1.4% resided in rural areas. In the multivariate mediation analysis, the total effect of rurality on prolonged TTS corresponded to an aOR of 0.89 (95% CI: 0.86-0.93), the direct effect corresponded to an aOR of 0.84 (95% CI: 0.79-0.89), and the indirect effect corresponded to an aOR of 1.10 (95% CI: 1.09-1.10). Over 50% of the total effect of rurality on prolonged TTS was mediated by proximity to treatment facility. After adjusting for clinical and sociodemographic factors, TTS of 61-90 days was associated with worse OS in both rural (HR 1.37, 95% CI: 1.14-1.63) and urban (HR 1.75, 95% CI: 1.72-1.78) patients, with comparable results observed for TTS >90 days.
conclusionsAlthough geographic proximity to care mediates the relationship between rurality and prolonged TTS, rurality has an intrinsic protective effect on TTS that is independent of the adverse effect of increased distance to care.
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