Impact of geography on Scottish cancer diagnoses in primary care: Results from a national cancer diagnosis audit

Peter Murchie* (Corresponding Author), Rosalind Adam, Wei Lynn Khor, Sarah Smith, Emma McNair, Ruth Swann, Jana Witt, David Weller

*Corresponding author for this work

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A recent meta-analysis of global research found cancer patients living in rural locations are 5% less likely to survive than their urban counterparts, a survival disadvantage that has never been satisfactorily explained.

[1] To describe and compare primary-care involvement in the diagnosis of cancer between rural and urban patients in Scotland. [2] To compare the length of key diagnostic pathway intervals between rural and urban cancer patients in Scotland.

Participating GPs in the Scottish National Cancer Audit of cancer diagnosis (2017) collected data from primary-care medical records on the diagnostic pathway of patients diagnosed in 2014. Residential postcodes designated the patients as rural or urban dwellers. Key cancer diagnostic pathway intervals (primary, diagnostic, secondary, and treatment) were compared using binary logistic regression. Descriptive analysis included comparison of patient characteristics, and routes to diagnosis.

73 Scottish general practices provided data on 1,905 cancer diagnoses. Rural patients did not have higher odds of prolonged diagnostic intervals compared to urban patients but were significantly more likely to have had a cancer alarm feature at presentation and three or more primary-care consultations prior to referral. Rural GPs were significantly more likely to perceive an avoidable delay in their patient’s diagnostic pathway.

There was no evidence that rural patients were more likely to be subject to prolonged cancer diagnostic delays than urban patients. Rural patients may experience primary care differently in the lead-up to a cancer diagnosis. The effect on outcome is probably negligible, but further research is required to confirm this.
Original languageEnglish
Article number101720
Number of pages8
JournalCancer Epidemiology
Early online date30 Apr 2020
Publication statusPublished - Jun 2020

Bibliographical note

The National Cancer Diagnosis Audit (NCDA) in Scotland received enabling support from Cancer Research UK and the Scottish Government.

This audit used data provided by patients and collected by NHS as part of their care and support. The authors would like to thank all GPs and health professionals who participated in the NCDA in Scotland, the members of the NCDA Steering Group, as well as contributing staff at Cancer Research UK; Information Services Division (NHS Scotland); Scottish Government; the Royal College of General Practitioners; and Macmillan Cancer Support. National Cancer Diagnosis Audit (2014) Steering Group: Sue Ballard (patient †), Patricia Barnett, David H Brewster, Cathy Burton, Anthony Cunliffe, Jane Fenton-May, Anna Gavin, Sara Hiom (chair), Peter Hutchison, Dyfed Huws, Maggie Kemmner, Rosie Loftus, Georgios Lyratzopoulos, Emma McNair, John Marsh (patient), Jodie Moffat, Sean McPhail, Peter Murchie, Andy Murphy, Sophia Nicola, Imran Rafi, Jem Rashbass, Richard Roope, Greg Rubin, Brian Shand, Ruth Swann, Janet Warlow, David Weller, and Jana Witt.


  • cancer
  • clinical audit
  • diagnosis
  • delay
  • primary care
  • rurality
  • Clinical audit
  • Primary care
  • Delay
  • Diagnosis
  • Cancer
  • Rurality


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