Geographic disparities in thyroid cancer staging at presentation: Insights from an Australian context.

Abstract

Thyroid cancer diagnoses have increased over recent decades at a rate much higher than that of any other cancer in Australia. Rural patients are known to have reduced access to healthcare and may have different thyroid cancer presentation rates. This study examined the relationship between thyroid cancer diagnosis and patient rurality. Data from the Australia and New Zealand Thyroid Cancer Registry from 2017 to 2022 were analyzed, stratifying patient postcodes into rurality groups using the Australian Statistical Geography Standard. The American Thyroid Association (ATA) guidelines were used to stratify risk categories and management to compare treatment adequacy between the groups. Statistical analysis assessed demographic, clinical, and management differences. Among 1766 patients, 70.6% were metropolitan (metro) and 29.4% were non-metropolitan (non-metro). Non-metro patients were older at diagnosis (median 56 vs. 50years, p<0.001), presented more frequently with T stage greater than 1 (stage 2-4, 41.9% vs. 34.8%, and p=0.005), AJCC stage greater than 1 (stage 2-4, 18.5% vs. 14.6%, and p=0.019), and cancers larger than 4cm (14.3% vs. 9.9%, p=0.005). No significant differences in treatment adequacy were observed between the groups for ATA low-risk cancers. Non-metropolitan patients in the registry present with more advanced thyroid cancer, possibly due to differences in healthcare access. Further research should assess long-term survival outcomes and influencing factors. Understanding the impact on patient outcomes and addressing healthcare access barriers can optimize thyroid cancer care across geographic regions in Australia.