Perspective from the Mississippi Delta: Could rural living be a risk factor for more advanced gynecologic neoplasm? (430)

Abstract

Objectives: Endometrial cancer is the most common gynecologic malignancy in the United States, with obesity being a well-established risk factor. While several studies have shown a correlation between obesity and endometrial cancer, the primary goal of this study was to determine whether living in a rural versus non-rural area potentially led to a more advanced stage of the disease. Secondarily, this study sought to assess whether comorbid conditions, such as BMI > 40, hypertension, or diabetes, play a confounding role in disease severity. Methods: This study is an IRB-approved, retrospective chart review with inclusion criteria of BMI ≥30 and ICD diagnosis of endometrial cancer. Exclusion criteria were unavailable data and diagnoses other than endometrial cancer. There were 327 women over a 10-year timeframe who met the inclusion criteria. Among the study subjects, 58% of patients lived in areas classified as “rural,” while 42% of patients lived in “urban” areas. Results: This study demonstrated that when compared to women who lived in rural areas, women who lived in urban areas had a 70% lower risk of presenting with stage II endometrial cancer versus stage I (p=0.04). Furthermore, women living in the rural Mississippi Delta were three times more likely to present with stage IV endometrial cancer than women in urban Central Mississippi (p=0.03). This study revealed no association between survival status and area of residence (p=0.225) or survival status and BMI (p=0.173). In this study, women with diabetes were twice as likely to present with stage III disease (vs Stage I) than women who did not have diabetes (p=0.04). There was no significant difference in risk relative to disease stage in women with or without hypertension (p>0.05), and increasing BMI did not correlate to worsened disease stage at presentation. Conclusions: While this study did not demonstrate an association between the area of residence and overall survival status, it revealed a statistically significant difference in the presentation of advanced disease for patients living in rural versus urban areas. Patients who live in rural areas likely have more limited access to care and therefore present later in the disease process. The study findings indicate the importance of routine gynecologic care and screening in underserved areas of the state. Objectives: Endometrial cancer is the most common gynecologic malignancy in the United States, with obesity being a well-established risk factor. While several studies have shown a correlation between obesity and endometrial cancer, the primary goal of this study was to determine whether living in a rural versus non-rural area potentially led to a more advanced stage of the disease. Secondarily, this study sought to assess whether comorbid conditions, such as BMI > 40, hypertension, or diabetes, play a confounding role in disease severity. Methods: This study is an IRB-approved, retrospective chart review with inclusion criteria of BMI ≥30 and ICD diagnosis of endometrial cancer. Exclusion criteria were unavailable data and diagnoses other than endometrial cancer. There were 327 women over a 10-year timeframe who met the inclusion criteria. Among the study subjects, 58% of patients lived in areas classified as “rural,” while 42% of patients lived in “urban” areas. Results: This study demonstrated that when compared to women who lived in rural areas, women who lived in urban areas had a 70% lower risk of presenting with stage II endometrial cancer versus stage I (p=0.04). Furthermore, women living in the rural Mississippi Delta were three times more likely to present with stage IV endometrial cancer than women in urban Central Mississippi (p=0.03). This study revealed no association between survival status and area of residence (p=0.225) or survival status and BMI (p=0.173). In this study, women with diabetes were twice as likely to present with stage III disease (vs Stage I) than women who did not have diabetes (p=0.04). There was no significant difference in risk relative to disease stage in women with or without hypertension (p>0.05), and increasing BMI did not correlate to worsened disease stage at presentation. Conclusions: While this study did not demonstrate an association between the area of residence and overall survival status, it revealed a statistically significant difference in the presentation of advanced disease for patients living in rural versus urban areas. Patients who live in rural areas likely have more limited access to care and therefore present later in the disease process. The study findings indicate the importance of routine gynecologic care and screening in underserved areas of the state.