Abstract Purpose Survival from breast cancer is dependent on stage at diagnosis and some evidence suggests that rural women are more likely than urban women to be diagnosed with advanced stage ...disease. This systematic review and meta-analysis compared the stage of breast cancer at diagnosis between women residing in urban and rural areas. Methods PubMed (1951–2012), EMBASE (1966–2012), CINAHL (1982–2012), RURAL (1966–2012), and Sociological abstracts (1952–2012) were systematically searched in November 2012 for relevant peer reviewed studies. Studies on adult women were included if they reported quantitative comparisons of rural and urban differences in staging of breast cancer at diagnosis. Results Twenty-four studies were included in the systematic review and 21 studies had sufficient information for inclusion in the meta-analysis ( N = 879,660). Evidence indicated that patients residing in rural areas were more likely to be diagnosed with more advanced breast cancer. Using a random effects model, the results of the meta-analysis showed that rural breast cancer patients had 1.19 higher odds (95% confidence interval, 1.12–1.27) of late stage breast cancer compared with urban breast cancer patients. Conclusions Rural women were more likely than urban women to be diagnosed at a later stage. Preventive measures may need to target the rural population.
Abstract Background We identified breast screening patterns over time and patterns among women residing in rural and urban areas by sociodemographic factors. Methods This study employs a longitudinal ...design over 9 years from 2001 on 11,200 women aged 50 to 55 from the Australian Longitudinal Study on Women's Health. Area of residence was defined in accordance with the accessibility remoteness index of Australia Plus. Breast screening measures included mammography utilization, clinical breast examinations (CBE), and breast self-examinations (BSE). Findings Most women had a mammogram in the past 2 years in combination with CBE or BSE or both. Despite poorer access to mammography services, women residing in rural areas had similar mammography screening rates to their urban counterparts. Women residing in rural areas were less likely to have CBEs, but more likely to conduct BSEs. The breast screening behaviors were generally consistent over time. Conclusions The poorer breast cancer survival among rural women is unlikely to be explained by differences in mammography service use. A substantial proportion of the population may be experiencing overscreening by conducting all three types of breast screening.
