Likelihood of Obtaining Neoadjuvant Chemotherapy for Breast Cancer Across the Rural–urban Continuum

Introduction: Neoadjuvant chemotherapy (NAC) has shown promise for certain types of breast cancer to improve outcomes and reduce recurrence of disease. This study seeks to determine whether differences exist in the rates that breast cancer patients receive NAC versus surgery first based on area of residence. Methods: The National Cancer Database (NCDB) was queried for women with a diagnosis of breast cancer, where NAC was considered between 2004 and 2019. Analyses were stratified according to histopathologic subtype and geographic location as defined by the NCDB. Results: Of the 135,900 included patients, 53.9% received NAC and 46.1% had surgery first. In rural areas, patients were more likely to have received surgery first (51.6%) as opposed to NAC (48.4%) (P < 0.0001). In large metro areas, there was a greater proportion of patients receiving NAC than surgery first in all subtypes except for those with node-negative disease. Cases with any node positive disease, HER2 positive with tumor stage T1c or higher, triple negative with tumor stage T1c or higher, and stage 3, ER positive cancer were all found to have statistically significant (P < 0.0001) differences in treatment across the urban-rural continuum. Conclusions: Patients with breast cancer who are eligible for NAC treatment receive it at a lower proportion in rural areas than in metropolitan cities. Future studies are needed to determine whether this treatment difference influenced the clinical outcomes of the patients.