Study Finds That Compared to Urban Residents, Rural Residents Are More Likely to Have Fatalistic Beliefs About Cancer

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There is strong evidence showing that avoiding tobacco use, maintaining a healthy diet and weight, and being physically active are effective strategies for reducing cancer risk. In addition, the early detection of certain cancer types through screening has the potential to reduce cancer mortality by detecting cancer at an earlier, more treatable stage. Past research has also shown that the beliefs people hold regarding cancer may be barriers to practicing cancer prevention strategies.

A study by Jensen et al published in Cancer Epidemiology, Biomarkers & Prevention investigating rural and urban populations’ feelings of cancer fatalism and information overload has found that compared with urban populations, rural populations in the United States are more likely to exhibit cancer-related fatalism and information overload. Holding counterproductive cancer beliefs that undermine prevention and screening behaviors may be one explanation for the disproportionate cancer burden experienced by rural populations compared to their urban counterparts, according to the study authors.

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Study Methodology

The researchers analyzed the results from an online and in-person survey of 10,362 participants (3,821 rural and 6,541 urban) conducted between 2016 and 2020 in 12 National Cancer Institute–designated cancer centers to assess whether cancer beliefs vary between rural and urban adults. All participants were 18 and older and were predominately non-Hispanic White (81%) and female (57%).

The participants completed three items measuring cancer fatalism:

  • “It seems like everything causes cancer”
  • “There’s not much you can do to lower your chances of getting cancer”
  • “When I think about cancer, I automatically think about death.”

They also completed one item measuring cancer information overload: “There are so many different recommendations about preventing cancer, it’s hard to know which ones to follow.”

The response options included: “strongly agree,” “somewhat agree,” “somewhat disagree,” and “strongly disagree.”


The researchers found that compared with urban residents, rural residents were more likely to believe that everything causes cancer (odds ratio [OR] = 1.29, 95% confidence interval [CI] = 1.17–1.43), that prevention is not possible (OR = 1.34, 95% CI = 1.19–1.51), that there are too many different recommendations about cancer prevention (OR = 1.26, 95% CI = 1.13–1.41), and that cancer is always fatal (OR = 1.21, 95% CI = 1.11–1.33).

In addition to age, gender, and race/ethnicity, the surveys also collected a range of sociodemographic and behavioral variables among the participants, including income, education, employment status, primary source of health-care coverage, marital status, cost barriers to medical care, and smoking status. In particular, the researchers found that lower education was associated with cancer fatalism and information overload. According to the researchers, this might reflect differences in scientific literacy.

Improving Patient Communication to Counter Fatalism and Overload

“Our findings are in line with previous research showing that this type of thinking might be a consequence of a wider cultural setup that fosters self-reliance and coping beliefs in response to stress and lack of resources. This is known as psychological stress and coping theory,” said lead author Jakob Jensen, PhD, Professor in the Department of Communication at the University of Utah and member of the Huntsman Cancer Institute, in a statement. “The findings of our study are consistent with this logic as populations with fewer resources (in this case, rural adults) are more likely to reduce (fatalism) or revise (overload) the situation.”

According to the study authors, “Cancer centers and public health programs should consider whether existing resource allocation might cultivate these beliefs as well as how to position messages in light of fatalism and overload.”

Because participants seem overwhelmed by too many recommendations to reduce cancer risk, while at the same time perceive cancer as a death sentence that nothing can prevent, “New strategies to effectively integrate multiple recommendations at once would be helpful. Alternatively, the focus should be placed on one recommendation at a time,” stated Dr. Jensen.

Disclosure: For full disclosures of the study authors, visit

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.