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National Drop in Cancer Deaths Is Encouraging, but Inconsistent, as Improvements in Rural Areas Lag

The rate of cancer deaths has declined 27% in 25 years, but when it comes to cancers that can be effectively detected early, such as lung, cervical and colorectal, the outcomes for individuals in rural communities around the country are much worse than for those who live in more urban settings.
BY Dr. Len Lichtenfeld
PUBLISHED May 28, 2019
Recently, The American Cancer Society released its annual report on cancer statistics in the United States, which tells us quite a bit about cancer diagnoses and outcomes. The findings are widely quoted in the media and elsewhere and for good reason: They provide a wealth of information that can guide us on how to better detect and treat cancer in this country.

This year’s report had very positive information: The rate of cancer deaths declined 27% in 25 years. However, it also offered some observations that should be deeply concerning to all of us: When it comes to cancers that can be effectively detected early, such as lung, cervical and colorectal, the outcomes for individuals in rural communities around the country are much worse than for those who live in more urban settings. In contrast, for cancers for which there are no early detection tests, such as leukemia, we don’t see these differences.

The reasons are likely many, including factors that we know make a difference: education, social and economic status and access to care. These are the same issues that affect the availability of cancer care and make it more difficult to get the best treatment if you live in a location where expert facilities are not available or are many miles away.

There are no simple answers to this dilemma. Unfortunately, in some states, such as Georgia, rural hospitals are no longer financially sustainable, and their doors are closing. In many counties, basic health care from primary care clinicians isn’t available, let alone specialty care such as oncology. With the complexity of cancer care only increasing, it is unlikely that the situation will get better soon.

For me, the findings about the differences in outcomes for detectable cancers in rural communities was a bit of an eye-opener. It is one more symptom of a complex problem that we need to face. The concern is not just cancer care and treatment in our rural areas, but also survival rates for cancers we have the tools to diagnose early, when treatment is more effective and can make a real difference for many folks.

If we can’t meet that basic expectation — to detect and treat cancer early in its course, when we know it makes a difference — then how are we going to continue making the progress against cancer that we are clearly capable of making?

We need to find and employ innovative solutions to solve the disparities in outcomes for those who live in rural communities. We must provide access to appropriate cancer screening through innovative programs such as mobile screening, access to HPV vaccination and improvements in telemedicine. We should provide education and outreach about cancers and their detection, aimed at all ages, from children to the elderly. Finally, we need to help our communities, legislators and the leaders of state health programs understand that these differences in outcomes are very real — and deserving of their attention.

Dr. Len Lichtenfeld
Dr. Len Lichtenfeld is acting chief medical officer of the American Cancer Society.
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