By Alexis Puthussery
Rural Americans make up about 15% of the population, and according to the US census, rural healthcare disparities continue to increase for this population every year. In terms of cancer, the CDC states that cancer deaths for metropolitan communities decrease by about 1.6% every year, while for rural communities, the decrease is only 1%. While in terms of percentage, this difference may not seem significant, the difference accumulates every year and continues to worsen the current situation for rural citizens.
Rural and urban areas share three common types of cancer: breast, colorectal, and lung. Urban areas experience higher incident rates of breast cancer, while rural areas experience higher rates of colorectal and lung cancers. However, in all these cancers, rural areas experience higher overall mortality.
For breast cancer in particular, the importance of regular mammograms and screenings are vital to detecting cancer early and facing better odds and survival rates. A study conducted in midwestern America in 2020 found that Americans in rural areas experience lower rates of breast cancer screening and higher rates of late-stage breast cancer diagnoses than their more urban counterparts. The disparity between rural and urban Americans is not only found in cancer in general, but specifically in breast cancer as well. Much of the disparity is known, so how do we start to tackle the problem and work towards improving it? An ideal first step for rural communities would be to focus on breast cancer screening disparities. A greater emphasis on rural healthcare funding, such as testing and primary care centers in these locations should be put on state government agendas. Additionally, studies have found that healthcare professionals are less likely to move to rural areas, so special incentives or benefits could be put in place for healthcare providers who decide to move to rural America. The lack of physicians in rural areas affects much more than the screening aspect of breast cancer. When diagnosed, having to travel hours for treatment is a significant impediment and contributes to the many barriers to healthcare within rural areas. Joy Anderson, a healthcare worker from Fossil, Oregon, stated that people in her town have to travel 70 miles to see the nearest physician.
The effect this has on chemotherapy and/or radiation treatments, which have to be administered weekly, if not daily, is not hard to imagine. Programs like the California Oregon Medical Partnership to Address Disparities in Rural Education (COMPADRE) focus on placing doctors in rural areas and unrepresented areas should be supported, promoted, and funded. Another factor many rural patients experience is “breast cancer neglect.” Jennifer Lycette, M.D. has conducted research on this experience within rural areas and has found that these populations are more likely to delay, put off, or simply refuse breast cancer screenings. In one article, she describes her experience with a woman who had been neglecting a massive tumor for what Dr. Lycette believed for months or years. This woman also had bipolar disorder and was unable to receive mental health treatment. This contributed to her breast cancer neglect and eventually led to her death at 50 years old. Dr. Lycette’s work and findings show the multiple, confounding factors that contribute to rural breast cancer health disparities.
Neglect of mental health and lack of mental health resources, lack of healthcare education and access, and a general distrust of physicians stemming from a lack of access saturate Dr. Lycette’s research, but also reveal possible avenues to improve the rural health disparities. Studies have found that mental health prevalence is the same in both urban and rural areas, but accessibility, affordability, availability, and acceptability all pose barriers for rural areas, causing many people to go untreated. With primary care doctors and oncologists, centralizing more mental health professionals in rural areas would greatly improve the treatment of cancer. Promotion of mental healthcare in rural communities would not only help patients cope better with breast cancer once they are diagnosed, but help their loved ones cope and function as better caregivers as well. At the root of many stories like Dr. Lycette’s is a distrust of the healthcare system. Groups who have been systematically mistreated in the past by American healthcare, such as rural Americans, low-income Americans, and black Americans have grown weary of the field as a whole and not without reason. This was made extremely apparent during the pandemic and vaccine rollout. Trust needs to be rebuilt between the healthcare system and these groups. This can be done with effective outreach programs and on-the-ground healthcare intervention where rural citizens receive the same level of attention and care as those in urban areas. Additionally, to get to the root of the problem, medical and healthcare students should be taught about these disparities during their schooling, so that they are more responsible as providers to these populations. Finally, the best way to help rural communities struggling with healthcare disparities is to just ask them what they need. Matthew Gavidia for an article in the American Journal of Managed Care pointed out that the best people who know what a town or city needs are the inhabitants of said city or town. Therefore, personalized programs should be implemented, where immediate, specific needs of communities are the top priority.
There is more that can be and must be done in terms of fighting for more government funding for rural medical centers and promoting mental health within their communities and more rural physicians. While important, these are things that will take months or even years to see substantial effects. For those who need immediate solutions, the answer for what to do when diagnosed with breast cancer is not so simple. One helpful resource is the CDC’s National Comprehensive Cancer Control Program (NCCCP). The NCCCP provides cancer plans for every state on their website at They provide prevention measures and aid in treatment, all of which can be found on their website. Another resource for those in rural areas is the Rural Cancer Control portion of the National Cancer Institute’s website found here. This provides rural patients with possible treatment centers in their area.
Rural citizens face healthcare disparities on all fronts, and so when treating a disease as devastating as cancer, it is vital to improve access to healthcare, information, and education. Online resources are the best option for many rural citizens, but what will truly help is systematic change.
Continuing to vote for and promote programs and laws at the state level that will benefit breast cancer patients is how everyone can contribute to closing the enormous disparity rural citizens face.
