# Association of distance to diagnosis and area-based social measures with stage at diagnosis among Iowans with HPV-related cancers

## TL;DR

This study explores how distance to diagnosis and neighborhood characteristics in Iowa affect the stage at which HPV-related cancers are diagnosed.

## Contribution

The study introduces a novel analysis of how area-based social measures and geographic distance influence late-stage diagnosis of HPV-related cancers in a rural state.

## Key findings

- Greater distance to diagnosis is linked to later stage cervical cancer diagnosis.
- Environmental injustice is associated with later stage cervical cancer diagnosis.
- Higher poverty rates are linked to earlier stage vulvar/vaginal cancer diagnosis.

## Abstract

Human papillomavirus (HPV) causes oral and anogenital cancers, the incidence of which is increasing. Late-stage diagnosis is associated with increased mortality. Neighborhood-level characteristics and distance to place of diagnosis may impact timely diagnosis. Being a largely rural state, Iowa presents a unique location to understand the association between distance, neighborhood characteristics, and stage at diagnosis.

Data from the Iowa Cancer Registry from 2010 to 2021 were used to identify adults with HPV-associated cancers (cervical, oropharyngeal, vulvar/vaginal, anal/rectal, and penile). Four area based social measures (ABSMs) were used to operationalize neighborhood characteristics: proportion of families living in poverty, proportion of households participating in food stamps, social vulnerability index, and environmental justice index. Distance was measured from the centroid of a person’s census tract to their treatment facility. For each cancer type, we ran four logistic regression models, adjusting for sociodemographic characteristics, to assess associations between distance and each of the ABSMs independently with our outcome, late stage diagnosis.

Among those with cervical cancer, greater distance to diagnosis was associated with later stage at diagnosis, irrespective of ABSM controlled for. Among those with cervical cancer, greater environmental injustice was associated with later stage at diagnosis (OR = 1.78, 95% CI = [1.02,3.09]). Among those with vulvar/vaginal cancer, greater proportion of families in poverty was associated with earlier stage at diagnosis (OR = 0.31, 95% CI = [0.12, 0.78]). There were no interactions between ABSMs and distance to care.

It is important to consider ABSMs and distance to care when identifying those at-risk of late-stage diagnosis.

The online version contains supplementary material available at 10.1007/s10552-025-02066-4.