Rural-Urban Disparities in Breast Cancer: Six Suppositions and Future Directions

Abstract

Disparities in breast cancer outcomes between rural and urban populations are of great interest as environmental, social, and technological processes unevenly affect rural and urban landscapes. This chapter examines research on rural-urban disparities in breast cancer. The first section briefly reviews recent literature on variations in breast cancer incidence, stage, survival, quality of life, treatment and costs in rural and urban areas. The next section critically evaluates this work by presenting six suppositions about rural and urban places and populations. Each supposition discusses a key issue concerning how rural and urban categories and disparities are defined, measured, and analyzed. I argue that rural and urban are complex, heterogeneous categories that are difficult to define and that change over time complicates our understanding of breast cancer disparities. The complexity, heterogeneity, and dynamism of urban and rural places and populations give rise to unequal and varying BC outcomes. In addition, people’s differing experiences of urban and rural places strongly influence important risks and exposures, while also affecting access to diagnosis and treatment facilities, leading to people- and place-based heterogeneity in breast cancer outcomes. Implications for future research on rural-urban disparities are discussed.