title: Patients Diagnosed with Colorectal Cancer in Rural Areas in Arizona Typically Present with Higher Stage Disease.
abstract: BACKGROUND
  Despite the decreasing incidence of colorectal cancer (CRC) over the past three decades disparities remain in its incidence, stage at presentation, and efficiency of staging and treatment between different communities, particularly when comparing urban and rural areas. The aim of the study was to assess disparities that exist in CRC outcomes among urban, international border counties, and non-border counties in Arizona.
  
  
  METHODS
  A retrospective analysis of CRC data from the Arizona Cancer Registry was performed. Data obtained included age, sex, ethnicity, tumor grade, and tumor stage. The data was then categorized into three sections: international border counties, urban counties, and rural counties. The outcome measure was stage of CRC at diagnosis.
  
  
  RESULTS
  There were a total of 39, 958 reported incident cases of colorectal cancer from 1995-2010. Of the total incident cases, 53.1% were male and the average age at diagnosis was 69.5. 86.6% were white non-Hispanic, 8.37% Hispanic, 2.4% African American, 1.7% Native American and 1% Asian. There was a significant decrease in the incidence of CRC in all counties, 24.08% in border, 22.5% in urban, and 12.3% in rural. Rural counties showed a higher number of observed cases than expected cases of stage 4 CRC and more unknown diagnosis of grade, stage and lymph node assessment as determined by the adjusted residual.
  
  
  CONCLUSIONS
  Patients in rural counties are more likely to present with a higher stage of CRC and are less likely to have their cancer adequately staged. This is likely due to lack of better access to healthcare, lack of awareness and poor education and also inadequate specialists.
authors: Department of Surgery, Division of Surgical Oncology, University of Arizona, Tucson, Arizona, USA.
authors: Valentine N
authors: VN
authors: Nfonsam
authors: Department of Surgery, Division of Surgical Oncology, University of Arizona, Tucson, Arizona, USA.
authors: Aparna
authors: A
authors: Vijayasekaran
authors: Department of Surgery, Division of Surgical Oncology, University of Arizona, Tucson, Arizona, USA.
authors: Viraj
authors: V
authors: Pandit
authors: Department of Surgery, Division of Surgical Oncology, University of Arizona, Tucson, Arizona, USA.
authors: Vera
authors: V
authors: E
authors: Department of Surgery, Division of Surgical Oncology, University of Arizona, Tucson, Arizona, USA.
authors: Hassan
authors: H
authors: Aziz
authors: Department of Surgery, Division of Surgical Oncology, University of Arizona, Tucson, Arizona, USA.
authors: Sumediah
authors: S
authors: Nzuonkwelle
authors: Department of Surgery, Division of Surgical Oncology, University of Arizona, Tucson, Arizona, USA.
authors: Eric
authors: E
authors: Ohlson
authors: Department of Surgery, Division of Surgical Oncology, University of Arizona, Tucson, Arizona, USA.
authors: Ryan M
authors: RM
authors: DiGiovanni
authors: Department of Surgery, Division of Surgical Oncology, University of Arizona, Tucson, Arizona, USA; Department of Pathology, University of Arizona, Tucson, Arizona, USA.
authors: Jana
authors: J
authors: Jandova
keywords: Arizona state; Colorectal cancer; Colorectal cancer stage; Rural Colorectal cancer