Most of us picture a cancer diagnosis against the backdrop of a big city hospital, with specialists down the hall. For millions of women, the picture looks very different. The ZIP code on the paperwork can quietly shape what happens next.
Two new studies from the American Cancer Society were presented this week at the ASCO Quality Care Symposium in Boston. They found that women in rural America now die from breast cancer at higher rates than women in big cities.
The gap did not exist a generation ago. It has widened steadily over the past decade. In the late 1990s, rural breast cancer death rates sat below urban ones. By 2018 to 2023, that pattern had reversed.
The gap that keeps widening
The first study tracked more than 2.8 million US women with breast cancer from 2010 to 2023. For 2010 to 2016, rural women were 3.4 percent more likely to die than women in large metro areas. By 2017 to 2023, that gap had nearly tripled to 9.3 percent.
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Jingxuan Zhao, a principal scientist in health services research at the American Cancer Society, led the first study. "What stands out is not simply that women in rural communities experienced worse breast cancer survival, but that the gap widened over time," she said.
A second analysis led by Xuesong Han, scientific director of health services research at the ACS, used national cancer registry data back to 1995. That longer timeline captured the full reversal.
A similar widening showed up for both White and Black women living in smaller counties, according to The ASCO Post.
What is driving the reversal
Only 11.2 percent of oncologists practice in rural America, according to the Rural Health Information Hub, a federally supported clearinghouse. The gap in care often starts long before a diagnosis.
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Women in rural regions are less likely to have ever had a mammogram, and less likely to have had one in the past two years. About 60 million people live in rural America, and roughly half of rural cancer survivors report serious financial strain from their diagnosis.
The ACS researchers point to a familiar mix of causes behind the shift. Longer travel distances to oncology specialists, fewer screening facilities, and treatment delays stacked across months of appointments all pull survival downward.
What women in rural counties can do
Lisa A. Lacasse, president of the American Cancer Society Cancer Action Network, said that where a woman lives should not shape her chances of surviving the disease.
Early mammogram screening remains the most studied way to catch breast cancer when treatment works best. Women who have gone more than two years without a mammogram, or who have never had one, can call a primary care clinic to arrange a referral.
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This article is made and published by Jesper Bengtson, who may have used AI in the preparation.