Objective: The purpose of this study was to examine differences in presentation, surgical management, and mortality among breast cancer patients in the National Cancer Database (NCDB) based on area of residence. Methods: The NCDB was queried for women with a diagnosis of breast cancer from 1 January 2004–31 December 2015. The data were divided by metropolitan (large, medium, small) and non-metropolitan (urban, rural) status. Results: Cancer stage increased with rurality (p < 0.0001). Residency in a large metropolitan area was associated with increased breast reconstruction rates (odds ratio [OR] 1.25, 95% confidence interval [CI] 1.19–1.30) and reduced overall mortality (hazard ratio 0.92, 95% CI 0.89–0.95) compared with rural areas. There was no difference in mastectomy use among small metropolitan (OR 1.03, 95% CI 1.01–1.04), urban (OR 0.99, 95% CI 0.98–1), and rural areas (OR 1.05, 95% CI 1.01–1.07) compared with large metropolitan areas. Conclusions: Across the rural–urban continuum in the NCDB, stage of cancer presentation increased with rurality. Conversely, residency in a large metropolitan area was associated with higher reconstruction rates and a reduction in overall mortality. Future studies should evaluate factors contributing to advanced disease presentation and lower reconstruction rates among rural breast cancer patients.
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