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Is breast cancer more aggressive when developed by rural-dwellers compared to those living in the city?

Project Description

Rural-dwellers have poorer survival when they develop cancer compared to equivalent urban-dwellers.[1] Despite a large number of studies demonstrating this effect the root causes of poorer rural cancer survival have never been explained.[2] Recent work in Northeast Scotland demonstrated that rural-dwellers here are, in fact, diagnosed and treated more quickly than urban counterparts, but continue to have poorer one-year survival.[3] Although patients included in the study were no more likely to have metastatic disease at presentation we were unable to explore important factors of tumour biology. It is possible, but unknown, that biological and/or genetic factors could play an important role in determining different rural and urban cancer outcomes. Work from the USA has, for example, demonstrated clustering of more aggressive prostate cancers in men living in rural counties in Maryland.[4] Recent work by geneticists using genetic data from 2,554 individuals has demonstrated extensive geographic structuring in Scotland raising the possibility that rare genetic variants could be concentrated in rural areas.[5] The possibility exists that poorer rural outcomes are caused by difference in the genetic make-up of rural populations with a tendency for rural people to determine more aggressive tumours which are less likely to be survived.

[1] To conduct systematic reviews of global literature exploring the relationship between urban and rural residence, stage at diagnosis, survival and biological factors in breast cancer and prostate cancer.
[2] To develop a data-linked cohort of women diagnosed with breast cancer and men diagnosed with prostate cancer in Scotland to explore the relationship between place of residence, personal characteristics, tumour biology and survival.
[3] To identify prospectively, patients with prostate cancer or female breast cancer and pilot data collection methods to allow rural-urban variations to be examined in subsequent genetic studies.

First, the student will conduct a systematic review of global literature which explores the interplay of geography, demographics, tumour biology and cancer outcomes for women with breast cancer. The student will work with supervisors and a medical librarian to develop a review protocol which will be registered with Prospero. Following screening of title and abstracts relevant articles will be obtained for dual assessment of quality and data-extraction. Synthesised data will establish current knowledge on the state of current knowledge on the interplay of geography, individual characteristics and tumour biology in breast cancer outcomes globally.

Second, student will map the construction of a Breast and Prostate Cancer Geography dataset. The dataset will include national and local data from sources including the Scottish Cancer Registry, the NHS Grampian Cancer Care Pathway database, and locally-held pathology data. Statistical analyses will explore the relationship between place of origin/residence, personal characteristics, tumour biology and clinical outcomes. Multiple regression modelling will be used to examine the relationship between subjects’ place of origin/residence, tumour biology, diagnostic pathway, stage at diagnosis and survival, allowing adjustment for key confounders. The potential for geographic clustering of particular tumour types will be explored using spatial cluster analysis.

Third, directed by supervisors the student will design and establish the data collection methods for a future prospective study of geography and cancer genetics. These future studies will likely involve the recruitment of patients at diagnosis with subsequent collection of granular demographic and behavioural data and biological samples (tissue, blood samples) for detailed biological and genetic profiling.

This project is advertised in relation to the research areas of APPLIED HEALTH SCIENCE. Formal applications can be completed online: You should apply for Degree of Doctor of Philosophy in Applied Health Science, to ensure that your application is passed to the correct person for processing.


Candidates should contact the lead supervisor to discuss the project in advance of submitting an application, as supervisors will be expected to provide a letter of support for suitable applicants. Candidates will be informed after the application deadline if they have been shortlisted for interview.

Funding Notes

This project is part of a competition funded by the Institute of Applied Health Sciences. Full funding is available to UK/EU candidates only. Overseas candidates can apply for this studentship but will have to find additional funding to cover the difference between overseas and home fees (approximately £16,625 per annum).

Candidates should have (or expect to achieve) a minimum of a First Class Honours degree in a relevant subject. Applicants with a minimum of a 2:1 Honours degree may be considered provided they have a Distinction at Masters level.


1. Murchie P, Turner M, Adam R, Carierre R, Wood R, Field S. The future of primary care rural cancer research: a commentary on Murage et al. Fam Pract 2019; 1-2; doi:10.1093/fampra/cmy132

2. Carriere R, Adam R, Fielding S, Barlas R, Ong Y, Murchie P. Rural dwellers are less likely to survive cancer – An international review and meta-analysis.. J Health Place 2018;53:219-227 –

3. Turner M, Fielding S, Ong Y, Dibben C, Feng Z, Brewster DH, Black C, Lee A, Murchie P. A cancer geography paradox? Poorer cancer outcomes with longer travelling times to healthcare facilities despite prompter diagnosis and treatment: a data-linkage study. Brit J Cancer 2017;117:439-449 – Published Online June 22nd - DOI:10.1038/bjc.2017.180

4. Klassesn AC, Kulldorff M, Curriero F. Geographical clustering of prostate cancer grade and stage at diagnosis, before and after adjustment for risk factors. Int J Health Geog 2005;4:1 DOI: 10.1186/1476-072X-4-I

5. Gilbert E, O’Reilly S, Merrigan M et al. The genetic landscape of Scotland and the Isles. Proc Natl Acad Sci 2019;116 DOI: 10.1073/pnas.1904761116

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