Breast Cancer: Urban vs Rural Diagnosis Disparities Interview with:
Deirdre McLaughlin PhD MAPS
Associate Professor, Principal Research Fellow
Centre for Longitudinal and Lifecourse Research
Janni Leung, BHS
School of Population Health
University of Queensland What are the main findings of the study?

Answer: Breast cancer patients living in rural areas were diagnosed later than breast cancer patients living in urban areas. Evidence from Australia, Egypt, Italy, Canada, Poland, South Africa, Denmark, and parts of the United States indicated that patients residing in rural areas were more likely to be diagnosed with more advanced breast cancer. Our meta-analysis showed that rural breast cancer patients had 1.19 higher odds (95% confidence interval= 1.12-1.27) of diagnosis of a late stage breast cancer compared to urban breast cancer patients. What are the possible explanations?

Answer: Mammography is likely to detect early stage tumors and the differences in diagnostic stage between women living in rural and urban areas have been attributed to the lower take-up of screening services among rural women. Our results indicate that rural women are diagnosed with later stage breast cancer and this may be reflective of difficulty accessing cancer screening services in rural areas. However, it may also indicate decreased awareness of the importance of regular breast screening or the significance of attending to early symptoms. This may be related to rural disadvantage in accessing preventive cancer care. What recommendations do you have for future research as a result of this study?

Answer: The examination of health disparities between urban and rural populations is important because breast cancer is the most prevalent cancer in women. Although a significant proportion of the world’s population resides outside urban areas, most research focuses on urban samples. As a result, the number of studies available for review was limited. Studies from the United States represented 13 of the 24 studies reviewed and the remaining studies were drawn from Australia (2), New Zealand (2), Denmark (1), Canada (1), South Africa (1), Egypt (1), Italy (1), Norway (1) and Poland (1) and this limits the generalizability of our conclusions. Furthermore, in the small number of studies that included both urban and rural samples, there were some variations in the definition of rurality and urbanity across different studies. Findings of rural and urban differences in breast cancer stage may differ across different states or areas within each country. The rural population is under-represented in the existing literature and has been under-researched. Simply generalizing findings from urban populations to rural populations is not appropriate. Researchers could usefully agree on a standard definition of ‘rurality’ to allow more coherent comparisons across studies. What should clinicians and patients take away from your report?

Answer: Since breast cancer is the most prevalent cancer in women and it is one of the few cancers for which population screening technologies are available, early detection of breast cancer should be emphasized in order to ensure a higher survival rate. Preventive cancer care, particularly screening programs in rural areas, may help reduce the health discrepancy. Rural healthcare providers should be encouraged to opportunistically discuss breast cancer screening when seeing eligible female patients.


Disparities in breast cancer stage at diagnosis in urban and rural adult women: a systematic review and meta-analysis
Sallyanne Nguyen-Pham, Janni Leung, Deirdre McLaughlin
Annals of Epidemiology – 30 December 2013 (10.1016/j.annepidem.2013.12.002)