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Cancer Epidemiol Biomarkers Prev. 2018 Sep;27(9):1036-1046. doi: 10.1158/1055-9965.EPI-18-0210. Epub 2018 Jul 9.

Rural-Urban Disparities in Time to Diagnosis and Treatment for Colorectal and Breast Cancer.

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Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia.
Department of General Practice and Centre for Cancer Research, Victorian Comprehensive Cancer Centre, University of Melbourne, Melbourne, Australia.
Division of Surgery, Ballarat Health Services, Ballarat, Australia.
Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark.
Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom.
Gynaecological Cancer Research Centre, London, United Kingdom.
Department of Health and Human Services Victoria, Victorian Government, Melbourne, Australia.
Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia.
School of Psychology, Deakin University, Burwood, Australia.


Background: Longer cancer pathways may contribute to rural-urban survival disparities, but research in this area is lacking. We investigated time to diagnosis and treatment for rural and urban patients with colorectal or breast cancer in Victoria, Australia.Methods: Population-based surveys (2013-2014) of patients (aged ≥40, approached within 6 months of diagnosis), primary care physicians (PCPs), and specialists were collected as part of the International Cancer Benchmarking Partnership, Module 4. Six intervals were examined: patient (symptom to presentation), primary care (presentation to referral), diagnostic (presentation/screening to diagnosis), treatment (diagnosis to treatment), health system (presentation to treatment), and total interval (symptom/screening to treatment). Rural and urban intervals were compared using quantile regression including age, sex, insurance, and socioeconomic status.Results: 433 colorectal (48% rural) and 489 breast (42% rural) patients, 621 PCPs, and 370 specialists participated. Compared with urban patients, patients with symptomatic colorectal cancer from rural areas had significantly longer total intervals at the 50th [18 days longer, 95% confidence interval (CI): 9-27], 75th (53, 95% CI: 47-59), and 90th percentiles (44, 95% CI: 40-48). These patients also had longer diagnostic and health system intervals (6-85 days longer). Breast cancer intervals were similar by area of residence, except the patient interval, which was shorter for rural patients with either cancer in the higher percentiles.Conclusions: Rural residence was associated with longer total intervals for colorectal but not breast cancer; with most disparities postpresentation.Impact: Interventions targeting time from presentation to diagnosis may help reduce colorectal cancer rural-urban disparities. Cancer Epidemiol Biomarkers Prev; 27(9); 1036-46. ©2018 AACR.

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