Inequalities in breast cancer incidence and stage distribution between urban and rural female population in Świętokrzyskie Province, Poland
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Department of Hygiene, Epidemiology and Ergonomics, Medical University, Bialystok, Poland
Department of Public Health, Medical University, Bialystok, Poland
Department of Epidemiology and Biostatistics, Witold Chodźko Institute of Rural Health, Lublin, Poland
Department of Medical Anthropology, Institute of Rural Health, Lublin, Poland
Dominik Maślach   

Department of Public Health, Medical University of Bialystok, Poland
Ann Agric Environ Med. 2019;26(1):159–164
Introduction and objective:
One of the main factors determining the burden of breast cancer is the effectiveness of measures taken to combat this cancer including urban-rural differences. The aim of the study was to analyse the differences in breast cancer incidence and disease stage distribution among urban and rural women in the Świętokrzyskie Province as a part of a strategy for breast cancer control.

Material and methods:
The study of disease stage distribution included 483 female residents of Świętokrzyskie Province who were diagnosed in 2013 with invasive breast cancer, and reported to Świętokrzyskie Office for Cancer Registration. Urban-rural differences in breast cancer incidence in 2002–2013 were presented using Range Ratio (RR). Changes in incidence trends in urban and rural areas were analysed using joinpoint models. Annual Percentage Change (APC) of the rates was calculated for each time trend.

Breast cancer incidence rate in the urban female population was higher than in rural women with RR, amounting to 1.43. However, the analysis of trends showed that the pace and direction of change were developing negatively among inhabitants of rural areas. In 2002–2013, in rural women, the age-standardized rate (ASR) values increased by 2.8% per year (p<0.05). The course of ASR trends showed statistically significant urban-rural differences (p=0.004). Analysis of urban-rural differences in disease stage distribution revealed a non-significantly higher proportion of cases with localised stage in urban than in rural areas, amounting to 51.0% and 43.9%, respectively.

Existing health inequalities indicate the need to intensify activities in rural areas and should be the starting point for making key decisions in combating breast cancer.

This research was financed under Project ERA-NET TRANSCAN 1/2015, financed by the National Centre for Research and Development in Warsaw, pursuant to Decision No. DZP/TRANSCAN III/168/2015.
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