Rural-Urban Disparities in Breast Cancer: Six Suppositions and Future Directions

McLafferty, Sara

doi:10.1007/978-3-030-18408-7_16

Cited by 4 publications

(3 citation statements)

References 63 publications

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“…Our sensitivity analysis investigating rural-urban difference shows that associations between breast cancer and the environment can differ between rural and urban contexts. This supports previous findings that rural-urban disparities exist in breast cancer 44,45,51 , in particular that environmental exposures can often have larger effects in urban areas 36 . It also suggests that individual factors driving poor environmental quality and associated with higher breast cancer incidence in urban areas may be different than those factors involved in these associations in rural areas.…”

Section: Discussionsupporting

confidence: 91%

“…Urbanicity has previously been associated with spatial variation of disease, including breast cancer [42][43][44][45] . We first evaluated incidence rates by summary stage comparing across rural versus urban counties using Mann-Whitney rank tests, since not all stages were normally distributed, confirmed by the D' Agostino-Pearson normality test.…”

Section: Rural-urban Sensitivity Analysismentioning

confidence: 99%

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Cumulative environmental quality is associated with breast cancer incidence differentially by summary stage and urbanicity

Gearhart-Serna,

Mills,

Hsu

et al. 2023

Sci Rep

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Individual environmental contaminants have been associated with breast cancer; however, evaluations of multiple exposures simultaneously are limited. Herein, we evaluated associations between breast cancer summary stages and the Environmental Quality Index (EQI), which includes a range of environmental factors across five domains. The EQI (2000–2005) was linked to county-level age-standardized incidence rates (SIRs) obtained from the North Carolina Central Cancer Registry (2010–2014). Incidence rates and SIRs of total, in situ, localized, regional, and distant breast cancers were evaluated stratified by rural–urban status. In counties with poor environmental quality compared to those with good environmental quality, total breast cancer incidence was higher by 10.82 cases per 100,000 persons (95% CI 2.04, 19.60, p = 0.02). This association was most pronounced for localized breast cancer (β = 5.59, 95% CI 0.59, 10.58, p = 0.03). Higher incidence of early-stage disease (carcinoma in situ β = 5.25, 95% CI 2.34, 8.16, p = 0.00 and localized breast cancer β = 6.98, 95% CI 2.24, 11.73, p = 0.00) and total breast cancer (β = 11.44, 95% CI 3.01, 19.87, p = 0.01) occurred in counties with poor land quality, especially urban counties. Our analyses indicate significant associations between environmental quality and breast cancer incidence, which differ by breast cancer stage and urbanicity, identifying a critical need to assess cumulative environmental exposures in the context of cancer stage.

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Section: Discussionsupporting

confidence: 91%

Section: Rural-urban Sensitivity Analysismentioning

confidence: 99%

Cumulative environmental quality is associated with breast cancer incidence differentially by summary stage and urbanicity

Gearhart-Serna,

Mills,

Hsu

et al. 2023

Sci Rep

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“…Sociodemographic and personal factors associated with vulnerable populations significantly impact the late stage at breast cancer diagnosis of the majority (two-thirds) of African patients and minority groups in high-income- countries. These include a general lack of knowledge and awareness of breast cancer and its symptoms, large distances to travel to cancer diagnostic and treatment facilities for rural women [ 31 ] low literacy rates, poverty associated with black race [ 32 ] particularly in rural African settings [ 33 ] and minority groups in high-income settings [ 34 , 35 ], lower levels of education, high unemployment, extremes of age, (very young and very old), fear of the disease and its treatments and associated stigma; unaffordability of treatments, religious and cultural issues to name but a few [ 8 , 11 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

The South African breast cancer and HIV outcomes study: Profiling the cancer centres and cohort characteristics, diagnostic pathways, and treatment approaches

Mapanga,

Ayeni,

Chen

et al. 2023

PLOS Glob Public Health

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The South African Breast Cancer and HIV Outcomes prospective cohort (SABCHO) study was established to investigate survival determinants among HIV-positive and HIV-negative SA women with breast cancer. This paper describes common and unique characteristics of the cancer centres and their participants, examining disparities in pathways to diagnosis, treatment resources and approaches adopted to mitigate resource constraints. The Johannesburg (Jhb), Soweto (Sow), and Durban (Dbn) sites treat mainly urban, relatively better educated and more socioeconomically advantaged patients whereas the Pietermaritzburg (Pmb) and Empangeni (Emp) sites treat predominantly rural, less educated and more impoverished communities The Sow, Jhb, and Emp sites had relatively younger patients (mean ages 54 ±14.5, 55±13.7 and 54±14.3 respectively), whereas patients at the Dbn and Pmb sites, with greater representation of Asian Indian women, were relatively older (mean age 57 ±13.9 and 58 ±14.6 respectively). HIV prevalence among the cohort was high, ranging from 15%-42%, (Cohort obesity (BMI ≥ 30 kg/m2) at 60%, self-reported hypertension (41%) and diabetes (13%). Direct referral of patients from primary care clinics to cancer centre occurred only at the Sow site which uniquely ran an open clinic and where early stage (I and II) proportions were highest at 48.5%. The other sites relied on indirect patient referral from regional hospitals where significant delays in diagnostics occurred and early-stage proportions were a low (15%- 37.3%). The Emp site referred patients for all treatments to the Dbn site located 200km away; the Sow site provided surgery and endocrine treatment services but referred patients to the Jhb site 30 Km away for chemo- and radiation therapy. The Jhb, Dbn and Pmb sites all provided complete oncology treatment services. All treatment centres followed international guidelines for their treatment approaches. Findings may inform policy interventions to address national and regional disparities in breast cancer care.

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Influence of rurality on lymph node assessment among women diagnosed with ductal carcinoma in situ and treated with mastectomy, SEER 2000–2015

Riley

Chrischilles

Lizarraga

et al. 2022

Breast Cancer Res Treat

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Rural-Urban Disparities in Breast Cancer: Six Suppositions and Future Directions

Cited by 4 publications

References 63 publications

Cumulative environmental quality is associated with breast cancer incidence differentially by summary stage and urbanicity

Cumulative environmental quality is associated with breast cancer incidence differentially by summary stage and urbanicity

The South African breast cancer and HIV outcomes study: Profiling the cancer centres and cohort characteristics, diagnostic pathways, and treatment approaches

Influence of rurality on lymph node assessment among women diagnosed with ductal carcinoma in situ and treated with mastectomy, SEER 2000–2015

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