Rural Cancer Less Common, More Deadly

September 21, 2017

Photo of Jane Bolin, Director of Texas A and M Southwest Rural Research Center
Clinicians in Texas found alarming rates of colorectal abnormalities in 1,870 patients after instituting a cancer prevention  program serving rural communities. More than a third had abnormal pathologies and nearly one in four had cancer precursors. Researchers say a gap in screening in rural areas leads to higher death rates that are preventable.

 

People who live in rural areas get most types of cancer less often than urban dwellers, but they are more likely to die from the disease, a federal epidemiologist and other experts reported in a recent webinar.

Moreover, those differences in cancer mortality rates are on the rise in rural America – which comprises some 59 million people. With about 19 percent of the U.S. population, rural areas are served by only nine percent of practicing physicians.

Contributing factors, researchers say, range from longer travel distances for treatment, to engrained misconceptions that prompt some to delay or forego treatment until it's too late – resulting in higher death rates for cancers of the lung, colon and rectum, prostate and cervix, the federal Centers for Disease Control and Prevention reported in July.

Jane Bolin, who oversees a Texas prevention project, says outreach workers are essential to break down cultural and social barriers through direct, person-to-person encounters.   

"Rural-urban disparities in cancer incidence and mortality extend across the entire cancer control continuum, from prevention and behavioral risk factors, detection, diagnosis, treatment, and survivorship," said HRSA Administrator Dr. George Sigounas, who saw the effects personally as a researcher and a professor of medicine for more than two decades at East Carolina University.

The webinar followed a CDC report comparing cancer rates over a nine-year period.

"Whether it's urban or rural, cancer is always very personal," said Paul Moore of HRSA's Federal Office of Rural Health Policy. "Cancer is also always challenging, but often more challenging if you live in rural America."

Rural counties had higher diagnosis and deaths rates from several cancers related to tobacco use and inadequate screening, said CDC's Jane Henley.

The figure shows two line graphs illustrating trends in annual age-adjusted incidence rates for 2004-2013 in nonmetropolitan and metropolitan counties, by year of diagnosis. Cancer sites include lung and cervix. Also shown are average annual percentage changes (AAPCs) for nonmetropolitan and metropolitan counties (lung: nonmetro AAPC = -1.2%, metro AAPC = -1.9%, nonmetro late-stage AAPC = -0.9%, metro late-stage AAPC = -1.8%; cervix: nonmetro AAPC = -1.5%, metro AAPC = -1.4%, nonmetro late-stage AAPC = -0.3% [NS], metro late-stage AAPC = -0.7%).
While death rates nationwide from common forms of cancer have been declining, they remained higher in rural counties -- and began to rise again in 2010 for cervical cancer, despite wide availability of screening and vaccines.

 

Urban-rural gaps also reflect differences in risk factors for obesity, while disparities in death rates suggest that rural residents more often suffer from poor access to health care and timely treatment, the experts agreed.

"Unfortunately, studies have shown time after time that where people live in the country can affect the diseases they get, how they die and when they die," Henley said. "Geography should not be a risk factor. It alone cannot predict cancer risk, but it can impact prevention, diagnosis, and treatment opportunities."

Fighting rural cancer- clockwise from upper-left: A billboard campaign in South Carolina is typical of efforts in rural states to correct misconceptions about cancer fatality that inhibit many from seeking screening and treatment; Geography should not be a risk factor, says Jane Henley of the CDC; Map from the American Public Health Assoc. shows gross disparities in HPV vaccination adherencee in predominately rural states; Robert Croyle of the National Cancer Institute;  Paul Moore of HRSA's Federal Office of Rural Health Policy;  Federal and state supported mammovans are now in operation across the country to detect breast cancer in remote communities; Dr. George Sigounas, who taught for two decades at a rural-focused medical school, said cancer disparities exist across the entire cancer control continuum.
Fighting rural cancer: (clockwise from upper-left): A billboard campaign in South Carolina is typical of efforts in rural states to correct misconceptions about cancer fatality that inhibit many from seeking screening and treatment; "Geography should not be a risk factor," says Jane Henley of the CDC; Map from the American Public Health Assoc. shows gross disparities in HPV vaccination adherence in predominately rural states; Robert Croyle of the National Cancer Institute;  Paul Moore of HRSA's Federal Office of Rural Health Policy;  Federal- and state-supported "mammovans" are now in operation across the country to detect breast cancer in remote communities; Dr. George Sigounas, who taught for two decades at a rural-focused medical school, said cancer disparities exist "across the entire cancer control continuum."

 

Lack of ready access to transportation, medical professionals, facilities and staff may cause people in rural areas to delay getting care, speakers said.

So, too, might social attitudes, including mistrust of institutions, which have been known to impede research studies in rural areas, suggested Robert Croyle of the National Cancer Institute.

There is also a cultural factor Croyle described as "cancer-related fatalism."

"This is something we see in several regions of the country, like Appalachia, where people presume that cancer is less preventable and less treatable than it actually is."

Surveys of rural cancer patients conducted by Texas A&M University showed that a  complex web of reasons inhibit people from getting screenings and treatment.
Surveys of rural cancer patients conducted by Texas A&M University showed that a  complex web of reasons inhibit people from getting screenings and treatment.

 

Yet locally designed cancer screening efforts, patient education, an emphasis on vaccinations and provider training may help reduce rural cancer risks, said panelists in the webcast -- the latest installment in a series sponsored by the Rural Health Information Hub in cooperation with the CDC.

The most effective models for driving down cancer rates are local and community-driven, said Bolin of the Texas A&M Health Science Center.

One is the Texas Cancer Screening, Training, Education and Prevention Program, or "Texas C-STEP."

It provides colorectal, breast and cervical cancer safety-net services, including screenings and cancer education to poor and uninsured residents in a mostly rural, 17-county region of central Texas.  

At the same time, C-STEP trains medical school residents, nurse practitioners, community health workers and other clinicians.

Date Last Reviewed:  October 2017


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