Access to recommended cancer screening is more difficult for rural residents than their urban counterparts. Factors inhibiting screening include local availability, low socioeconomic status of rural residents, and minority status. As a result, rural patients may present at later stages than urban patients due to delays in detection. The goal for this study was to compare adjusted rates of early and late breast and colorectal cancer staging at diagnosis between patients residing in urban and three categories of rural counties (micropolitan adjacent to metropolitan, micropolitan non-adjacent to metropolitan and small and remote rural). Using Surveillance, Epidemiology and End Results Program (SEER) cancer registry data, we identified and classified breast and colorectal cancer cases diagnosed in 2010-2014 as early or late stage diagnoses. We ran logistic regressions using patient and county level control variables, and general estimating equations to account for patients clustering within counties. We calculated, compared and reported the adjusted rates of urban and rural breast and colorectal cancer patients that present as late stage cancer cases overall and for different sociodemographic characteristics, cancer types, and regions of residence. We also calculated adjusted rates for rural patients in different county types.

Publications

• The Association of Rurality and Breast Cancer Stage at Diagnosis: A National Study of the SEER Cancer Registry
  Policy Brief
  WWAMI Rural Health Research Center
  Date: 10/2021
  Patients from rural areas have lower breast cancer screening rates and poorer cancer outcomes than urban patients and received initial breast cancer diagnosis at a later stage compared with urban patients. Black race and being uninsured were also associated with late stage at diagnosis. Patterns have persisted and suggest areas for policy change.
• Investigating the Impact of Geographic Location on Colorectal Cancer Stage at Diagnosis: A National Study of the SEER Cancer Registry
  Journal Article
  WWAMI Rural Health Research Center
  Date: 08/2019
  Access to recommended cancer screening is more difficult for rural than urban residents. As a result, rural patients may present at later stages than urban patients due to delays in detection. This study compared the adjusted rates of and late colorectal cancer staging at diagnosis between patients residing in urban and rural counties.