Differences in cancer stage presentation between rural and urban patients

Armen Hareyan's picture
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New research published in the November issue of The Journal of the American College of Surgeons shows that urban colorectal and lung cancer patients present at later stages of disease than rural patients do. This finding is contrary to the common assumption that rural patients with cancer present at a later stage of disease in comparison with urban patients.

"The proportion of urban patients presenting with metastatic cancer is alarming," said Ian Paquette, MD at Dartmouth-Hitchcock Medical Center, Lebanon, NH. "This study highlights the need for better screening efforts for colorectal cancer and the need to develop an effective screening program for people at high risk for lung cancer."

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A retrospective, descriptive analysis of cancer stage at presentation was conducted to determine the relationship between stage of disease and whether patients lived in rural or urban areas. Lung cancer patients (161,479) and colorectal cancer patients (129,811) from 2000 to 2003 were identified in the Surveillance, Epidemiology, and End Results (SEER) database. Rural versus urban designations were based on rural-urban continuum codes (RUCC) from the US Department of Agriculture.

Overall, the study indicated that urban patients are presenting with later stages of colorectal and lung cancers when controlling for the other demographic factors associated with late presentation (p<0.001). Notably, rural colorectal cancer patients were older and considerably poorer than urban patients, while urban colorectal cancer patients were considerably more likely to be language-isolated, African American, and divorced. Rural lung cancer patients were considerably poorer than urban patients, and they were more likely to be men. Urban lung cancer patients had demographics equivalent to the urban colorectal patients.

Although several factors, including race, socioeconomic status, age, and divorce, had an influence on cancer stage at presentation, rural residence was not shown to be an independent predictor of later-stage disease.

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