Where a woman lives has a significant impact on whether breast cancer is diagnosed early or at a later stage, according to a national analysis published in . Journal of the American College of Surgeons (jacks). The researchers found that there were significant geographic differences within rural areas across the United States, and that race and insurance status also had a significant impact on the stage of a woman’s breast cancer at the time of diagnosis.
Geographical disparities were very pronounced. We found that among different rural areas across the country, a woman’s geographic residence was one of the key factors influencing her risk of being diagnosed with advanced-stage breast cancer, with the highest disparity rates in the South. ”
Omolade Sogade, MD, MPHS, lead author of this study and resident surgeon at Washington University in St. Louis, Missouri
Rural women are known to be at increased risk of advanced breast cancer, but geographic differences within rural communities and the factors that drive these disparities are poorly understood. Researchers used the American College of Surgeons (ACS) National Cancer Database to analyze data on 52,287 rural women diagnosed with breast cancer between 2004 and 2021. Counties were defined as rural if there were no towns or cities, or if the largest town had fewer than 2,500 residents. The researchers used U.S. Census regions and divisions to categorize rural areas.
Characteristics of rural breast cancer patients
Among rural patients, 13.6% were diagnosed with advanced breast cancer (stage 3 or 4) compared to 12% of non-rural patients.
Most rural patients were white (84%), aged 50 to 69 years at diagnosis (53%), and resided in the West North Central, South Atlantic, and Southeast South Central regions (67%). The majority of patients were covered by Medicare (47%) or private insurance (39%), and more than half (62%) lived in the bottom half of the income distribution (median income less than $57,856).
Approximately half of the patients were treated in comprehensive community cancer programs. After adjusting for other factors, facility type was not associated with advanced-stage diagnosis.
Geographical differences in rural areas
Using the West North Central region (Iowa to Dakota) as a statistical reference point, the researchers found:
- Women in the Southeast Central region (Alabama, Kentucky, Mississippi, and Tennessee) were about 34% more likely to be diagnosed with stage 4 breast cancer.
- Women in the West South Central region (Arkansas, Louisiana, Oklahoma, and Texas) were 33% more likely to be diagnosed with stage 4 breast cancer.
racial disparity
Compared to white women,
- Black women were 58% more likely to be diagnosed with stage 3 breast cancer and 28% more likely to be diagnosed with stage 4 breast cancer.
- Hispanic women were 52% more likely to be diagnosed with stage 3 breast cancer.
Insurance status and risk
Insurance coverage greatly influences the diagnosis stage.
- Compared to patients with private insurance, uninsured women were approximately twice as likely to be diagnosed with stage 3 breast cancer and nearly four times as likely to be diagnosed with stage 4 breast cancer.
- Although Medicaid coverage provided some protection, it was still associated with an increased risk of developing advanced breast cancer. Women with Medicaid were almost three times more likely to be diagnosed with stage 4 breast cancer than patients with private insurance.
Breast cancer is highly treatable when detected early, but outcomes decline rapidly as the disease progresses. According to the American Cancer Society, the five-year survival rate for breast cancer patients ranges from 87% to 99% if the breast cancer has not spread beyond nearby lymph nodes, but drops to about 33% in advanced stages.
Addressing disparities in rural areas
Several factors may contribute to delays in breast cancer diagnosis in rural areas. The authors noted that about 60% of rural counties lack a practicing general surgeon, and only about 3% have medical oncologists who practice primarily in rural areas. Long distance travel, labor shortages, limited access to screening, and low health literacy can further delay diagnosis.
The authors emphasize that solutions must be multifaceted and region-specific. Expanding access to screening, strengthening the local surgical workforce, and aligning health policy to local needs are important steps. Programs such as fellowships offered through the ACS Rural Surgery Program are designed to train surgeons to practice in rural areas.
“Rural cancer disparities are complex and driven by multiple factors,” said FACS senior author Julie Mergenthaler, MD, ACS governor, professor of surgery and chief of breast surgery at Washington University School of Medicine in St. Louis, Missouri. “Effective solutions must be locally tailored and delivered with a deep understanding of local barriers and unique needs. Surgical training is essential, but so is prevention, early detection, and the provision of comprehensive cancer care.”
The authors noted that the study relied on hospital-level data from the National Cancer Database, which may not capture individual factors that contribute to delays in diagnosis. Larger population-level analyzes may reveal patient-specific barriers to timely breast cancer detection in rural areas.
The results of this study were presented at the 137th Southern Surgical Society Annual Meeting (December 2025, Hot Springs, VA) and published as a press article. jacks Website.
sauce:
American College of Surgeons
Reference magazines:
Sogade, O., & Margenthaler, J. (2026) Evaluation of factors associated with the development of advanced stage breast cancer in rural patients in a national cancer database. Journal of the American College of Surgeons. DOI: 10.1097/XCS.0000000000001759. https://journals.lww.com/journalacs/abstract/9900/evaluating_factors_associated_with_advanced_stage.1537.aspx
