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

Rebecca J Bergin, Jon Emery, Ruth C Bollard, Alina Zalounina Falborg, Henry Jensen, David Weller, Usha Menon, Peter Vedsted, Robert J Thomas, Kathryn Whitfield, Victoria White

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)1036-1046
Number of pages11
JournalCancer Epidemiology, Biomarkers and Prevention
Issue number9
Early online date9 Jul 2018
Publication statusPublished - Sep 2018


  • Adult
  • Aged
  • Aged, 80 and over
  • Australia/epidemiology
  • Breast Neoplasms/diagnosis
  • Colorectal Neoplasms/diagnosis
  • Delayed Diagnosis
  • Early Detection of Cancer
  • Female
  • Follow-Up Studies
  • Health Services Accessibility
  • Healthcare Disparities/statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Prognosis
  • Rural Population/statistics & numerical data
  • Social Class
  • Time-to-Treatment
  • Urban Population/statistics & numerical data


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