Comparison of breast cancer surgery cases in urban and rural areas: Clinical factors and patient-reported outcomes

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.

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.

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).

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.