Brachytherapy Deserts in Texas: Assessment of Geographic Availability of Brachytherapy Centers

Summary: Brachytherapy is a critical component of definitive cervical cancer treatment. Timely access to treatment has shown an improved survival benefit. Texas is the second largest state by size and population in the US. Here we explore the geographic availability of brachytherapy centers in the state. We queried publicly available data on cervical cancer incidence and mortality between 2010- 2020 from the Texas Cancer Registry. Available brachytherapy centers were compiled from the Texas Department of State Health Services (DSHS) Radiation Control Program and verified by direct contact with each treating institution. Number of brachytherapy units per 1,000 new cases was calculated as an index of brachytherapy availability. The state currently has 48 active brachytherapy institutions treating cervical cancer with definitive tandem & ring/ovoid modality. Texas DSHS geographically divided the state into 11 public health regions (PHR) to support and coordinate the local health needs of the entire state. PHR 8 located in the south-central region has the lowest availability of centers (1.23 centers/1,000 new cases), while PHR 1 in the north region has the highest availability (8.73 centers/1,000 new cases). The overall Texas incidence rate, mortality rate, and brachytherapy availability is 9.4 per 100,000 (US rate 7.7), 2.8 per 100,000 (US rate 2.6), and 3.43 per 1,000 new cases, respectively. It is estimated that 45% of cases present as locally advanced in Texas. The overall state locally advanced incidence rate is 4.2 cases per 100,000 population, which is 55% higher than the national locally advanced incidence rate of 2.7. Roughly 31% of all cervical cancer patients die from the disease in Texas, whereas 10% die on average annually in the US. On the county level, Henderson County has the highest mortality rate (5.8 deaths per 100,000 population) and zero brachytherapy availability. Hidalgo County located on the southern border has the highest absolute number of incidence (500) and deaths (157) for a county without a major metropolitan city. Fort Bend County has the highest absolute incidence (263) and deaths (90) for a county without any brachytherapy centers. Angelina County has the highest incidence rate (15.9 per 100,000) with a non-zero death rate (3.9 per 100,000). Here we highlight the cervical cancer rate discrepancies between Texas and the US along with the counties and regions without adequate brachytherapy access to take care of the highest at risk populations. The state needs more geographic availability of high-quality brachytherapy centers and well-trained brachytherapists to treat cervical cancer. Mayank Patel, MD (Presenting Author) - University of Miami