A recent study conducted by the American Cancer Society (ACS) highlights how geographic location in the United States increasingly influences a person’s likelihood of developing and surviving cancer. Published in the Journal of the National Cancer Institute (JNCI), the study reveals a significant long-term shift in cancer burden, moving from urban areas to rural regions. Researchers found that the mortality gap between urban and rural areas has continued to widen over the past several decades.
The study attributes higher cancer mortality rates in rural areas to several factors, including limited access to healthcare, lower cancer screening rates, higher poverty levels, and greater prevalence of smoking and other behaviors that contribute to cancer risk. By analyzing trends in cancer mortality across rural and urban areas, researchers hope to provide insights into the disparities and guide public policy aimed at reducing them.
Dr Farhad Islami, senior scientific director of cancer disparity research at the ACS and lead author of the study, emphasized that differences in cancer risk factors and unequal access to early detection and treatment are significant contributors to the growing cancer burden in rural areas. These disparities reflect broader inequalities in social determinants of health, which encompass environmental conditions where people are born, live, work, and age, and which profoundly affect health outcomes.
Key Study Findings:
Researchers analyzed data from 27,710,318 cancer deaths across a 55-year period (1969-2023), using records from the National Center for Health Statistics. The study examined overall cancer mortality rates and trends for the leading causes of cancer deaths in men and women: lung, colorectal, female breast, and prostate cancers.
- Historical Trends:
- From 1969-1971, large metropolitan areas had the highest overall cancer mortality rates, followed by smaller metropolitan and non-metropolitan areas. Non-metropolitan areas with the smallest urban population (under 5000) had the lowest rates
- By 2021-2023, the pattern reversed. Non-metropolitan areas with the smallest urban populations had the highest cancer mortality rates, whereas large metropolitan areas had the lowest. This reversal occurred in the 1990s for men and in the early 2000s for women, with the rural-urban mortality gap widening thereafter
- Specific Cancer Trends:
- For lung cancer, the rural-urban gap grew notably. Among men, lung cancer mortality in non-metropolitan areas (urban population under 5000) was 26% lower than in large metropolitan areas from 1969-1971 but became 55% higher from 2021-2023
- Colorectal and breast cancer mortality showed similar trends, though the timing of the crossover varied
- Prostate cancer mortality rates were comparable across urbanicity categories from 1969-1971 but became higher in less urbanized areas by 2021-2023
Rural Cancer Survivors:
A separate ACS study led by Dr Hyunjung Lee and published in the journal MED examined disparities among cancer survivors living in rural and deprived areas. Results showed that cancer survivors living in rural areas generally had poorer health outcomes and were less likely to seek primary or specialized healthcare compared with those in urban or affluent areas. These findings underscore the importance of addressing healthcare access barriers in underserved communities.
Dr Lee emphasized the need for team-based survivorship care that includes oncologists, primary care clinicians, nurse practitioners, and mental health professionals. Proposed solutions include expanding telehealth services, establishing satellite clinics, workforce training programs, and empowering non-oncologists to provide care. Tailored approaches are necessary to accommodate the unique needs and resources of different communities.
Call to Action:
Lisa A. Lacasse, president of the ACS Cancer Action Network, highlighted the urgency of addressing these disparities. She urged lawmakers to support policies that improve access to affordable, comprehensive healthcare and to ensure health plans maintain robust networks. Such measures would enable patients to access essential healthcare professionals and treatments, ultimately reducing the overall cancer burden.
The findings of the ACS studies emphasize the importance of ensuring equitable healthcare access across all geographic regions. They also point to the need for systemic changes in healthcare delivery, public health initiatives, and policies that promote fair opportunities for cancer prevention, detection, treatment, and survival for all individuals, regardless of where they live.
American Cancer Society. Cancer in rural areas. American Cancer Society Pressroom. Published October 2023. Accessed October 8, 2023. https://pressroom.cancer.org/cancer-in-rural-areas
