Urban Americans diagnosed with cancer later

NEW YORK (Reuters Health) - Americans living in urban areas tend to be diagnosed with colon and lung cancer later than rural residents are, according to a new study.

The findings, published in the Journal of the American College of Surgeons, stand in contrast to conventional wisdom. It's commonly thought that Americans in rural areas seek care for potential cancer symptoms later than their urban counterparts.

The study findings indicate that the common perception that rural patients consult a doctor at a more advanced cancer stage than urban patients do is not valid, report Dr. Ian Paquette and Dr. Samuel R.G. Finlayson of the Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire.

Using government cancer statistics for the years 2000 through 2003, the researchers found that out of nearly 130,000 U.S. residents diagnosed with colorectal cancer, those living in urban areas were slightly more likely to be diagnosed at a more advanced stage than rural dwellers were. The differences were small, but still meaningful.

For example, 17.93 percent of rural patients with colorectal cancer had the disease diagnosed at stage 4, the most advanced stage in which the cancer has spread to other organs, or "metastasized." That figure was 18.45 percent among urban patients.

A similar pattern was seen among the more than 161,000 Americans diagnosed with lung cancer during the study period, Paquette and Finlayson report.

The percentage of urban patients who are first seen with metastatic cancer is "alarming," Paquette said in a statement. "This study highlights the need for better screening efforts for colorectal cancer and the need to develop an effective screening program for people at high risk for lung cancer."

Experts advise all adults to begin having regular screening tests for colorectal cancer at the age of 50; those at higher-than-average risk of the disease should begin earlier and/or have screening tests more frequently.

It's not clear why urban residents were more often diagnosed at an advanced stage than rural residents were, according to the researchers. Urban patients were more likely to be relatively young, African American or non-English-speaking. However, even with these differences factored in, urban residence was still linked to later diagnosis.

The finding, Paquette and Finlayson write, "raises questions about how well screening is implemented in urban versus rural areas, and the overall effectiveness of cancer screening to prevent late-stage presentation."

SOURCE: Journal of the American College of Surgeons, November 2007.