Overall death rates from cancer are dropping nationwide.
But they’re higher in rural America.
This is despite the fact that overall incidence rates are lower in rural counties.
A new report from the Centers for Disease Control and Prevention (CDC) details cancer incidence and cancer death disparities in rural areas compared with urban areas.
Researchers used cancer incidence data from the CDC’s National Program of Cancer Registries and the National Cancer Institute’s Surveillance, Epidemiology, and End Results program (SEER).
Cancer deaths were calculated using the CDC’s National Vital Statistics System.
When it comes to cancer, where you live matters.
Socioeconomic status, lifestyle, and access to quality healthcare all play a role.
Between 2004 and 2013, annual age-adjusted incidence rates for all cancers combined decreased about 1 percent per year in both rural and urban communities.
When you combine all types of cancer, rural counties have an incidence rate of 442 cases per 100,000 people. In urban counties, it’s 457 per 100,000.
Rural counties had lower incidence rates for breast, prostate, stomach, liver, uterus, bladder, and thyroid cancers.
Rural counties have lower incidence rates than metropolitan counties — but similar to nonmetropolitan urban counties — for pancreatic cancer, myeloma, non-Hodgkin’s lymphoma, and other cancers.
But rural areas don’t have lower incidence rates for all types of cancer.
For example, there’s a higher incidence of cancers that are related to tobacco use, such as lung cancer.
And rural counties have higher rates of colorectal and cervical cancers. These can often be prevented with regular screening.
Rural areas had higher incidence rates for laryngeal cancer. When compared with urban counties with populations of more than 1 million people, rural areas have a higher incidence of melanoma and cancers of the oral cavity and pharynx, esophagus, and kidney.
When it comes to death rates, there’s another gap.
Overall, rural areas had higher cancer death rates at 180 deaths per 100,000 individuals. The death rate in urban areas is 158 per 100,000.
Rural counties had higher death rates from lung, colorectal, prostate, and cervical cancers.
This gap in death rates is also growing.
Between 2006 and 2015, the annual age-adjusted death rates for all cancers decreased 1.6 percent per year in urban areas. It decreased only 1 percent per year in rural areas.
Why the disparities?
“While geography alone can’t predict your risk of cancer, it can impact prevention, diagnosis, and treatment opportunities — and that’s a significant public health problem in the United States,” Dr. Anne Schuchat, the CDC’s acting director, said in a press release.
The agency’s report notes that differences in incidence between rural and urban counties may have something to do with risk factors such as smoking, obesity, and physical inactivity.
Differences in cancer death rates might be related to disparities in access to healthcare services.
Electra Paskett, PhD, co-leader of the cancer control research program at The Ohio State University Comprehensive Cancer Center, agreed with that assessment.
She told Healthline that we can expect an exponential rise in these disparities as some populations make gains in access to healthcare while others don’t.
Asked about the lower rates of breast and prostate cancer in rural counties, she explained that these cancers tend to be more common for people living in more prosperous communities. She pointed out that doesn’t mean it’s not a problem in rural areas.
“Late-stage presentation of breast cancer is higher in those populations. That has something to do with less access to screening,” she said.
“The biggest concern is lung, colon, and cervical cancers due to the higher prevalence of risky behaviors that cause them. We’ve seen these trends for a long time,” added Paskett, whose research program is nationally recognized for studying cancer health disparities.
She noted that the problem of smoking is bigger than lack of education.
“There are so many reasons why people smoke. It’s what they see people around them doing all their lives. It’s about social norms and a whole lot of other things,” she explained.
“What we have found in our research is that among women who live in low income or rural areas where there’s nothing to do, few jobs, and they’re stressed, is they cope by smoking and drinking. There’s lots of depression and they self-medicate with tobacco and alcohol,” she said.
In a paper published by the American Association for Cancer Research last year, Paskett wrote that lower socioeconomic status areas tend to have a higher per capita burden of stores that sell tobacco products and display tobacco advertising.
In rural Appalachia, Ohio, where Paskett conducts most of her research, many counties have no hospitals, no mammography facilities, and few places to get a colonoscopy. Lack of public transportation makes matters worse.
The same can be said of lower-income metropolitan areas.
Paskett’s paper points out that some low socioeconomic areas of Chicago do no better with breast cancer screening and treatment facilities.
Getting people screened is one part of the solution. Access to treatment is another.
“When you have abnormalities, people with the least resources and most stress are most likely to fall through the cracks. There aren’t enough checks and balances. That’s why we have so much late-stage diagnosis and mortality,” Paskett explained.
“I’m happy the report is out, but sad it didn’t come out earlier,” she added. “We’ve been doing the work in Appalachia for 15 years and seeing these trends that long. In rural areas, cancer is the number one cause of death. That should make people stop and think. A lot of it is preventable.”
A multilevel strategy
The CDC researchers laid out a number of strategies to reduce cancer incidence and deaths in rural areas.
Among them are promoting healthy behaviors that reduce risk, and increasing screenings and vaccinations. They also recommend participation at the state level through comprehensive cancer control programs.
Paskett is a big believer in a multilevel model approach to address health disparities.
What we need, she said, is to take it from biology all the way up to policy. That includes cooperation from local government officials, researchers, healthcare providers, and advocates.
She pointed to Chicago as an example of what can be accomplished.
“Death rates were 62 percent higher in black women. So they got a task force together with local government officials, researchers, healthcare providers, and advocates. They started mapping where facilities were located and where poorer women lived. The two never lined up,” she said.
The program needed help from legislators and payers to enact policy. And hospital navigators to perform community outreach.
“Chicago reduced disparity significantly. There’s still work to do but you can see that what they’re doing is working,” she continued. “We need buy-in from the top governors’ offices and state legislators. That’s what has to happen. When you have a whole city or state working on this problem together, you have an impact on disparities.”