People who live in the country are less likely to survive cancer

Bad for your health, this. Image: Getty.

It is easy to romanticise about escaping to the country, with its clean air, green space, and idyllic views. But our latest research, a review of 39 studies from around the world, suggests the need for a bit of an adjustment: it turns out that people living in rural locations are less likely to survive cancer.

We previously found that people in the northeast of Scotland who live more than an hour away from a cancer treatment centre are more likely to die within the first year after their diagnosis. We were interested in whether studies from other parts of the world also found differences between urban and rural cancer survival. We also wanted to understand reasons why people living rurally might be disadvantaged.

We examined studies that observed people with cancer over time. The studies calculated the risk of a person dying from cancer depending on whether they lived in urban or rural locations. One of the things that can complicate research comparing urban and rural living is that pockets of poverty can exist geographically, and poverty negatively affects cancer survival. For this reason, we only included studies that accounted for deprivation levels.

The 39 relevant studies that we found were all from developed countries, mostly the US, Canada, the UK and Australia/New Zealand. They covered a large variety of different cancer types and involved more than 2m people. Thirty of these studies found a clear survival disadvantage for rural people compared to their urban counterparts.

We wanted to find out exactly how much of a disadvantage rural patients had and we were able to aggregate the results of 11 of the studies. This led us to conclude that rural people are 5 per cent less likely to survive cancer than those living in urban areas.

Understanding why

The authors of the original studies suggested reasons why people living rurally might do worse after a cancer diagnosis. It is possible that they behave differently to city dwellers. They might be more likely to smoke or consume more alcohol, for example. It is also possible that rural people are more stoical, and might put off seeking help for symptoms.

The transport situation. Image: Sam Burriss/creative commons.

Access to services is also likely to be important. Most developed countries centralise their specialist cancer services within major cities, and this could potentially lead to disadvantages for rural people.

Some studies suggest that patients who live far away from specialist centres might be treated differently – not receiving radiotherapy, for example. Travel burden, transport infrastructure, and the way that cancer services are organised are important considerations. It might be, for example, that people in rural areas are more likely to avoid long journeys to city hospitals for treatments that will only make small improvements to their life expectancy.


Whatever the case, more research is needed to determine exactly which factors are at play, and which are the most important. Equally, it raises questions about survival rates for other illnesses in people living in the countryside.

There are many advantages to living in rural areas, and we are certainly not suggesting that everyone should move to the city. The big question is what we could do to improve cancer outcomes in people who live far away from cancer centres. Recognising that there is a problem is a good starting point, and research to build a deeper understanding of the problem could be coupled with innovative strategies to reduce rural cancer inequality.

One area of promise is digital/communications technology, such as getting people to communicate with clinicians via the internet. Possibilities would include everything from more automated appointment reminders to apps that help people to examine themselves online. On the whole, however, we need to better understand the problem better before we start proposing solutions. Having established that there is a definite disadvantage to living in the countryside if you have cancer, we now need to get to the bottom of it.

The Conversation

Rosalind Adam, Clinical Lecturer, University of Aberdeen; Peter Murchie, Professor of Primary Care, University of Aberdeen, and Romi Carriere, Doctoral Researcher, Epidemiology, University of Aberdeen.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

 
 
 
 

How can cyclists protect themselves against air pollution?

A female cyclist attempts to protect herself from air pollution. Image: Getty.

The popularity of cycling in London continues to rise: according to statistics published by Transport for London (TfL), the number of journeys made by bicycle in London grew by 5 per cent in 2018. The transport agency has attributed the upwards trend in cycling to its investment in cycling infrastructure, not least the seven Cycle Superhighways and 12 Cycle Quietways the city now boasts.

Cycling is widely reported to result in health benefits for participants, and cyclists can expect to achieve improvements in both their physical and mental health as a result of switching from public transport or car to a bike. But with air pollution levels remaining stubbornly high across London, should cyclists be concerned that the health benefits they achieve as a result of cycling are actually being outweighed by the dangers posed by increased exposure to air pollution? 

Unlike during the Great Smog of 1952, air pollution today is often invisible to the naked eye. Nonetheless, London breached the European and UK air quality annual limit on 18  March when, for the 36 time this year, levels of pollution particles recorded at a measuring post exceeded the agreed limit. (EU rules allow 35 breaches a year.) Whilst this is a marked improvement on 2018 when the annual limit was broken on the 5 January, it reminds us of the risk that air pollution continues to pose to Londoners today. 

The rise of respirator masks

Anyone who has cycled or walked along one of London's cycle paths in recent years is likely to have seen someone resembling Darth Vader cycling towards them. Protection masks, which are becoming increasingly popular amongst the cycling community, range from cotton surgical masks to respirators with in-built air filtration systems that cover a significant part of the cyclist’s face. 

But do masks actually work and are they worth the investment? 

Cotton masks categorically do not protect wearers against the inhalation of airborne particles. Whilst they can be somewhat effective in protecting against the spread of illnesses, they will not protect a cyclist from air pollution. 

Respirator cycling masks, which range in price from £25 to over £50, are a more sophisticated option. “N99” respirators are said to remove up to 99 per cent of airborne particles from inhaled air. But the particles that cause air pollution today are extremely small, which makes it particularly challenging for respirators to effectively block them from entering the human body. 

Another complicating factor is the fit of the respirator against the human face. Studies have concluded that under “perfect” conditions respirators do effectively filter pollution out of inhaled air. However, when actually fitted to a human face, respirators are often not able to form an effective seal against skin, which ultimately renders them useless. Features such as facial hair and short noses make is particularly challenging for a seal to form. 

The findings of studies into the effectiveness of respirator cycling masks are somewhat mixed – but point to the ineffectiveness of current designs. 


So what can cyclists do to protect themselves? 

The best intervention a cyclist can make to reduce their exposure to air pollution is to avoid the most polluted streets and roads. TfL’s Quietways are an easy way for cyclists to identify the less busy and less polluted roads (although TfL has announced it will be merging the Quietway and Cycle Superhighway networks into a single Cycleways cycle network during summer 2019). 

Cyclists may also consider reducing their cycling speed to reduce their inhalation of airborne particles. The faster and deeper we breathe in polluted air, the more pollutants are delivered to our lungs. Therefore slowing down and reducing their amount of exertion will go some way to protecting cyclists from air pollution. 

Finally, cyclists should check air quality forecasts and make informed decisions regarding their chosen mode of transport on a particular day. TfL provides daily forecasts on its website. 

So should cyclists stop cycling all together? In a word, no. Although there is currently not an effective way to stop yourself from inhaling air pollution whilst cycling, scientists have concluded that the physical and mental health benefits of cycling continue to outweigh the dangers posed by exposure to air pollution. Cycling remains a healthy method of transport for Londoners. 

If you are a cyclist who is concerned about your exposure to air pollution and you are considering investing in a respirator mask, be aware that research suggests they will not protect you effectively. Instead you may want to consider donating the money you would have spent on a respirator to a charity such as Trees for Cities, whose mission is to transform urban areas by creating Urban Forests.