ACS Studies Find Widening Rural-Urban Survival and Mortality Gaps for Women With Breast Cancer

Key takeaways:

• Women living in rural communities experienced worse breast cancer survival than those living in metropolitan areas.
• Before 2000, breast cancer mortality rates were lower in rural than in metropolitan areas, but in the most recent years, the gap reversed, and breast cancer mortality rates are now higher in rural than metropolitan areas.
• Barriers to cancer care in rural areas include longer travel distances, fewer oncology specialists, financial barriers, and limited access to screening, diagnosis, and treatment.
• Results highlight the need to strengthen rural healthcare infrastructure and access to quality cancer care.
  

ASCO Quality Care Symposium Abstract #208/Poster Board #F6/Session B
(Trends in survival disparity among women diagnosed with breast cancer by rural-urban residency in the U.S.)
ASCO Quality Care Symposium Abstract #253/Poster Board #H4/Session B
(Distant-stage Incidence and All-stage Mortality Trends of Cancers Amenable to Early Detection by Rural-urban Status in the United States, 1995-2023)

ATLANTA, October 12, 2026 - Life-saving advances in breast cancer care are failing to reach rural America equally. In two new, large studies led by the American Cancer Society (ACS), scientists found that survival and mortality disparities between rural and urban women diagnosed with breast cancer widened over time in the United States. The findings will be presented at the annual American Society of Clinical Oncology (ASCO) Quality Care Symposium in Boston, October 16-17, 2026.

"What stands out is not simply that women in rural communities experienced worse breast cancer survival, but that the gap widened over time," said Dr. Jingxuan Zhao, principal scientist, health services research at the American Cancer Society, and lead author of the study. "At a time when breast cancer detection and treatment have improved substantially, our findings raise concern that the benefits of those advances may not be reaching women in rural communities."

Researchers identified 2,821,166 women age 18 and older who were newly diagnosed with breast cancer between 2010 and 2023 from the National Cancer Database. Scientists compared survival after diagnosis among women living in large metropolitan, small metropolitan, and nonmetropolitan communities while adjusting for sociodemographic characteristics.

Study results showed that women with breast cancer living in small metropolitan and nonmetropolitan areas experienced worse survival than women living in large metropolitan areas. Among women living in nonmetropolitan areas with breast cancer, the rate of death was 3.4% higher than among women living in large metropolitan areas during 2010-2016, and this difference increased to 9.3% during 2017-2023. Similar patterns were observed across racial groups.

"Women living in rural areas often face longer travel distances, fewer oncology specialists, and more limited access to screening, diagnosis, and treatment services," Zhao added. "Strengthening rural healthcare infrastructure, reducing travel barriers, and improving access to cancer care could help ensure more women benefit from advances in breast cancer treatment."

The other study, led by Dr. Xuesong Han, used information from the North America Association of Central Cancer Registries' public research dataset and the National Center for Health Statistics mortality data from 1995 to 2023 to examine long-term trends in late-stage cancer incidence and mortality. Study results showed that breast cancer mortality rates were lower in rural areas than in urban areas during 1995-1999, but then reversed. By 2018-2023, breast cancer mortality rates were higher in rural areas than in urban areas.

"Your ZIP code shouldn't determine your cancer outcome," said Lisa A. Lacasse, president of the American Cancer Society Cancer Action Network, ACS' advocacy affiliate. "The challenges patients living in rural areas face in accessing cancer preventive and treatment services must be addressed. We urge lawmakers to support policies that help improve access to comprehensive, affordable health insurance and require health plans to maintain strong networks, so that patients can access the health care professionals and treatments they need, no matter where they live."

Other ACS researchers contributing to this study include Nova Yang, MSPH, Dr. Farhad Islami, Dr. Ahmedin Jemal, and senior author Dr. Robin Yabroff.

Additional ACS Resources:

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