Significant differences were found in advanced-stage diagnoses of breast cancer in rural populations according to geographic location in the United States, which were further influenced by demographic factors of race and insurance status, according to findings from an analysis of the National Cancer Database that was published in the Journal of the American College of Surgeons (JACS). Study findings were also presented at the 2025 Annual Meeting of the Southern Surgical Association.
“The geographic disparities were quite striking,” said lead study author Omolade Sogade, MD, MPHS, Resident in the Department of Surgery at Washington University in St. Louis, Missouri. “We found the highest rates of disparities in the South, and that even among different rural regions across the country, a woman’s geographic residence was one important factor impacting her risk of being diagnosed with advanced-stage breast cancer.”
Study Methods
The researchers looked at data from 52,287 patients with breast cancer living in rural areas from the years 2004 to 2021, which was collected from the National Cancer Database. They focused on clinicopathologic factors that could be associated with disease stage at diagnosis. For the purpose of the study, a rural area was defined as counties with no towns or cities, or where the largest town had fewer than 2,500 residents. The rural areas were defined according to U.S. Census regions.
Key Findings
Of all patients analyzed, 13.6% of patients living in rural areas were diagnosed at later stages vs 12% of patients who lived in nonrural areas.
Patients residing in the East South Central region (odds ratio [OR] = 1.28, 95% confidence interval [CI] = 1.07–1.52) as well as the West South Central region (OR = 1.33, 95% CI = 1.03–1.70) were both significantly more likely to be diagnosed with stage IV breast cancer than patients living in the West North Central region.
By race, non-Hispanic Black patients demonstrated higher risks of diagnosis at more advanced stages compared with non-Hispanic White patients (OR for stage II = 1.4, 95% CI = 1.26–1.55; OR for stage III = 1.58, 95% CI = 1.38–1.82; OR for stage IV = 1.29, 95% CI = 1.07–1.54). Hispanic patients showed a greater risk for being diagnosed with stage III breast cancer vs non-Hispanic patients (OR = 1.5, 95% CI = 1.03–2.20).
According to insurance status, uninsured patients showed progressively higher risks for being diagnosed with breast cancer at more advanced stages compared with insured patients (OR for stage II = 1.37, 95% CI = 1.12–1.68; OR for stage III = 2.06, 95% CI = 1.61–2.64; OR for stage IV = 3.88, 95% CI = 2.94–5.11).
Facility type did not show an association with advanced-stage diagnosis.
“Cancer disparities in rural areas are complex and driven by multiple factors,” said senior author Julie Margenthaler, MD, FACS, Professor of Surgery and Director of Breast Surgical Services at the Washington University School of Medicine in St. Louis, Missouri. “Effective solutions must be tailored to the region and informed by a deep understanding of local barriers and the community’s specific needs. Surgical training is essential, but prevention, early detection, and providing comprehensive cancer care are equally important.”
The study authors also acknowledged that larger population-level analyses are needed to identify patient-specific barriers that are possibly impacting breast cancer detection and diagnosis in rural areas.
DISCLOSURE: For full disclosures of the study authors, visit journals.lww.com.
