Patients who live in remote or very small rural communities are a bit more likely to show up at their doctor’s office with late-stage colon cancer than other Americans, which could help explain why patients who live in these areas have such poor colorectal cancer outcomes, a new study says.
The study, published in The Journal of Rural Health, looked at the relationship between late-stage colorectal cancer at diagnosis and county-level characteristics, including the level of rurality (how rural a place is), patient characteristics, and factors such as persistent poverty, low education, and low employment.
The study notes that cancer outcomes are often worse for rural patients, with various studies finding they have an 8 to 15 percent greater chance of dying from colon cancer.
“While rural communities overall have lower incidence of cancers compared to urban populations, they have higher cancer-related mortality rates,” says the report. In other words, people in the most rural areas are more likely to die from colon cancer even though they are less likely to get it in the first place.
The researchers identified 132,777 patients in Kentucky and nine other states who had colorectal cancer in 2010-14. After placing patients in five rural-to-urban categories, the study found that the adjusted percentages of stage 4 colon-cancer patients by county geography were: metropolitan areas, 19.3 percent; micropolitan areas (with a city of 10,000 to 50,000) adjacent to a metro area, 20.4%; non-adjacent micropolitan areas, 19.2%; small rural places, 20.2%; and remote rural places, 22.7%.
“Patients living in remote, small counties were significantly more likely to present with stage 4 colorectal cancer than patients living in other counties,” the study report says.
The data came from cancer registries in California, Connecticut, Georgia, Hawaii, Iowa, Kentucky, Louisiana, New Mexico, Utah and Washington. The registries included 352 rural and 235 urban counties, representing 18% and 20% of all rural and urban U.S. counties, respectively.
Among the 10 states studied, “Patients in Kentucky had the lowest adjusted rate (18.2%) of stage 4 diagnosis,” the report says.
Kentucky’s rate of colon cancer is the nation’s highest, but the state has been nationally recognized for getting its citizens screened for it. A University of Kentucky news release in March said the Kentucky Cancer Consortium received an award for its efforts to increase screening. The release said that between 1999 and 2016 screening rates in Kentucky rose from 35% to 70%, improving more than any other state in the country and moving the state from a ranking of 49th to 17th.
The study found that younger patients, black patients and single or widowed patients were more likely to present with late-stage colorectal cancer. The researchers note that these findings are consistent with decades of data and suggest that little or no improvement has been made in addressing these disparities.
It also found that a lack of insurance was the most significant predictor of late-stage diagnosis, which was also consistent with other research.
“Patient medical insurance categories had the greatest effects on the rate of stage 4 colorectal cancer at diagnosis. The rate was highest among uninsured patients (28.6%) compared to patients with any type of Medicaid insurance (24.4%) and other insured patients (18.4%).”
In addition to a known lack of screening services in rural areas, “the high cost of colonoscopy, access to specialty referral networks, lack of transportation, and lower health literacy may all play a role in these findings,” says the report.
The American Cancer Society recommends colorectal screening for average risk individuals to begin at the age of 45, instead of 50. Those with a family history of colon or rectal cancer should check with their doctor about getting screened earlier. Colon cancer is 90 percent curable when detected early.