Colorectal cancer kills rural Americans at a rate 27% higher than city dwellers, and strikes them 17% more often. The American Association for Cancer Research (AACR) published both figures in June, in its Cancer Disparities Progress Report 2026.
The context makes them harder to shrug off. National progress is real. The overall death rate has dropped by 35% since 1991, the AACR says, meaning more than 4.8 million fewer deaths and more than 18.6 million people now living as survivors. Some gaps have closed. Black Americans died of cancer at a rate 34% above White Americans in 1991; by 2024 the margin was 9%.
Rural America has not shared equally in that story.
Trials, screening and distance
One piece of the explanation is access to research itself. Research is thin on the ground too. As of 2022, over 70% of US counties hosted no active cancer trial, and the split was sharp: 86% of nonmetropolitan counties had none, against 44% of metropolitan counties. The report also found that screening for breast, cervical and colorectal cancer was lower among people with no usual source of care or no recent wellness visit.
The AACR’s steering committee chair, Mariana C. Stern of the Keck School of Medicine at the University of Southern California, put the problem in one sentence: “Unfortunately, these advances have not reached all populations equally.”
The group called for continued federal funding for cancer disparities research, for restoring and protecting federal cancer surveillance systems, and for Congress to protect Medicaid coverage of cancer screening and follow-up care.
Breast cancer shows the same drift
A separate American Cancer Society study points the same way. Among women diagnosed with breast cancer from 2017 to 2023, those in nonmetropolitan areas died at a rate 9.3% above women in large metropolitan areas. For 2010 to 2016 the difference was 3.4%.
Dr. Robin Yabroff, the society’s scientific vice president of health services research, described a reversal. “It used to be that women living in urban areas had higher late-stage diagnosis and mortality rates,” she said. Now rural women show higher mortality, more late-stage cancers and worse survival.
Yabroff pointed to fewer primary care providers, a shortage of oncology specialists and hospitals at risk of closing. Patients can end up driving long distances for screening, diagnosis and treatment, and then paying for transport and lodging on top of medical bills. Even insured patients struggle when specialty care sits outside their network or far from home. The society’s Hope Lodge program offers free lodging at 31 locations across the United States and Puerto Rico.
Sources
- AACR Releases Cancer Disparities Progress Report 2026 | News Releases | AACR
- AACR Releases Cancer Disparities Progress Report 2026 | News Releases | AACR
- American Cancer Society: New Study Finds Rural Women Face a Widening Gap in Breast Cancer Survival – RFD-TV
- AACR Releases Cancer Disparities Progress Report 2026 | News Releases | AACR
