Five-Year Cancer Survival Rates Lower Among Rural Cancer Populations

An American Cancer Society (ACS)–based study published in Cancer showed that 5-year cancer survival rates were lower among non-metropolitan patients who were Black and White in the US vs their metropolitan counterparts.¹

Specifically, in localized-stage, regional-stage, and distant-stage cancers, the overall survival (OS) rates among Black and White patients were 2%, 5%, and 3% to 7% lower in nonmetropolitan vs metropolitan areas, respectively. Additionally, among specific cancer types, the 5-year OS rate was typically lower in nonmetropolitan areas compared with metropolitan areas, with a greater difference observed in White patients. The largest difference among Black and White patients based on urbanicity was in localized-stage lung cancer, for an OS difference of about 12% and 10% lower in nonmetropolitan vs metropolitan regions for Black and White populations, respectively.

Additionally, the study found that disparities emerged among Black and White patients overall and stratified by urbanicity. For localized-stage cancers, the 5-year OS rate was 1% to 2% lower for Black patients after stratifying for urbanicity. Furthermore, the differences in 5-year OS rates between Black and White patients in large metropolitan areas were 7% lower for regional-stage cancers, at 61.8% (95% CI, 61.3%-62.4%) for Black patients vs 68.5% (95% CI, 68.3%-68.8%) among White patients.

For distant-stage cancers, the difference was also about 7% in large metropolitan areas, at 32.9% (95% CI, 32.5%-33.4%) vs 39.8% (95% CI, 39.6%-40.0%) in Black and White populations, respectively. In small-medium metropolitan areas, the difference was about 5%, at 31.3% (95% CI, 30.5%-32.2%) vs 36.1% (95% CI, 35.8%-36.4%), and in nonmetropolitan areas, it was about 4%, at 29.5% (95% CI, 28.1%-30.8%) vs 33.3% (95% CI, 32.9%-33.7%).

The differences between Black and White patients with specific cancers stratified by urbanicity showed a greater disparity in regional- and distant-stage breast cancers in large metropolitan areas vs nonmetropolitan areas. Additionally, the 5-year OS rate for localized-stage prostate cancer was lower by about 1% for Black patients in metropolitan areas vs White patients and as much as 4% for distant-stage cancers in large metropolitan areas. The 5-year OS rate was lower for Black patients with localized-stage lung cancer by 6% in large metropolitan areas vs 9% in nonmetropolitan areas vs White patients, with a difference of about 4% for regional disease in large metropolitan areas.

“Lower survival rates for cancers with the same stage at diagnosis in non-metropolitan areas largely reflect disparities in receipt of quality cancer care due to inequities in social determinants of health, including lack of insurance coverage,” Farhad Islami, MD, PhD, senior scientific director of Cancer Disparity Research at ACS and lead author of the study, said in a news release on the findings.² “This needs to change. Increasing access to cancer care to these historically marginalized populations is critically needed to mitigate disparities.”

The study collected data from the Surveillance, Epidemiology, and End Results (SEER) Program 22 cancer registries from patients 15 to 99 years old with any first primary invasive cancer or any lung, female breast, prostate, or colorectal cancer (CRC) diagnosed between 2015 and 2021. Non-Hispanic Black and non-Hispanic White patients were stratified by stage at diagnosis, age group, and urbanicity of county of residence, and 5-year, age-standardized, and cause-specific cancer survival was calculated.

When stratifying for age, racial differences in 5-year OS across all cancers were greater among patients younger than 65 years, particularly among those in large metropolitan areas. Additionally, the Black-White differences for breast cancer-specific regional- and distant-stage disease were greater in those younger than 65 years vs those 65 years and older. Furthermore, racial disparities were exacerbated for patients younger than 65 with regional- or distant-stage CRC in large metropolitan areas, but this difference was more pronounced among patients 65 years and older with regional-stage disease in nonmetropolitan areas.

Regarding receipt of cancer, the receipt of surgery for localized-stage or regional-stage cancers was lowest in nonmetropolitan areas vs metropolitan areas regardless of race. Additionally, the receipt of surgery was 12% to 14% lower among Black patients with localized-stage cancers vs 2% to 3% in regional-stage cancers regardless of urbanicity. Additionally, the disparity for localized-stage disease was slightly wider in nonmetropolitan areas (OR, 0.48; 95% CI, 0.47-0.50) vs large metropolitan areas (OR, 0.52; 95% CI, 0.52-0.53), but for regional-stage disease, it was slightly higher in large metropolitan areas (OR, 0.80; 95% CI, 0.79-0.81) vs nonmetropolitan areas (OR, 0.91; 95% CI, 0.87-0.95).

Moreover, Black patients were more likely to receive chemotherapy and radiotherapy for localized-stage cancers regardless of urbanicity but were less likely to receive treatment for distant-stage cancers compared with White patients.

References

1. Islami F, Wiese D, Schafer EJ, Sung H, Jemal A. Stage‐specific cancer survival in Black and White persons by urbanicity of county of residence, United States, 2015–2021. Cancer. 2025:131(19):e70073. doi:10.1002/cncr.70073
2. New ACS study finds cancer survival rates lower in rural areas, aligned with disparities in receipt of care. News release. American Cancer Society. September 24, 2025. Accessed September 25, 2025. https://tinyurl.com/5atn9rvw