Disparities in Breast Cancer Stage at Diagnosis in Urban and Rural Adult Women: A Systematic Review and Meta-Analysis

Ann Epidemiol. 2014 Mar;24(3):228-35. doi: 10.1016/j.annepidem.2013.12.002. Epub 2013 Dec 28.


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.

Keywords: Breast neoplasms; Meta-analysis; Neoplasm staging; Rural health; Urban health.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Breast Neoplasms / diagnosis*
  • Delayed Diagnosis
  • Early Detection of Cancer
  • Female
  • Healthcare Disparities*
  • Humans
  • Mammography / statistics & numerical data*
  • Mass Screening / statistics & numerical data*
  • Middle Aged
  • Neoplasm Staging
  • Patient Acceptance of Health Care
  • Residence Characteristics*
  • Rural Health
  • Rural Population / statistics & numerical data
  • Urban Health
  • Urban Population / statistics & numerical data