Urban-Rural Disparities in Female Cancer Incidence and Mortality in Trivandrum, South India

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Significant differences in cancer incidence between urban and rural women have been reported and for the same type of cancer, rural women are generally diagnosed at a later stage and have decreased survival rates as opposed to their urban counterparts. This has been shown for cancers such as breast, colo-rectum in both developed and developing countries. Rural women may suffer significant inequalities in terms of access to medical care and health awareness and these women tend to be less educated with lower economic means. Poorer hygienic conditions tend to aggravate physical threats in rural areas. Conversely, mechanized life-style, stress and air pollution are more widespread in urban environment.

Currently, lifestylehomogenization, particularly in developed countries, and the increased opportunities to healthcare access in rural population, has led to a minimal difference in cancer pattern. However, within Asia, large differences in cancer pattern are found between urban and rural population. Incidence rates of cancers such as cervix uteri, esophagus, stomach etc. are generally low in urban than rural population. In contrast to this, cancers such as breast, corpus uteri, ovary, colo-rectum etc. incidence rates are higher in urban than rural.

Cancer incidence particularly breast cancer among women in Kerala, South India, is a growing threat to public health. In urban Trivandrum other cancers such as corpus uteri, colo-rectum and kidney are also reported as the highest in the country (NCRP 2016). In Kerala, urban-rural difference according to education among women is minimal (literacy rate: 84.6% urban vs. 81.6% rural) (Census of India 2011) and the distances by road between the main oncology centers in Trivandrum and the rest of the regions are small. It is therefore possible to hypothesize that urban-rural differences in health care access is minimal. However, the magnitude and pattern of cancer incidence and mortality may differ by type of residence due to the difference in socio-demographic and life-style factors.