Public Health Strategies for Rural Cancer Policy Brief

Key points

  • Rural residents are more likely than urban residents to suffer and die from some of the deadliest but most preventable cancers.
  • Higher cancer rates in rural areas are associated with a lack of access to resources for the prevention, screening, treatment, and survivorship of cancer.
  • Find information, case studies, and other resources about rural cancer rates, and learn about ways to address them.
Mature Woman with Female Doctor


Cancer is the second leading cause of death in the U.S.1 It leads to about $88 billion in health care costs each year.2 But in rural areas, despite having fewer new cancer cases, the cancer death rate is higher than in urban areas.3 Also, rural residents have higher rates of some of the deadliest but most preventable cancers, such as lung, colorectal, and cervical cancer. Overall, rural areas are making less progress than urban areas in efforts to reduce the number of cancer cases and deaths in their communities.

Barriers affecting rural cancer rates

There are some primary barriers related to the prevention, screening, treatment, and survivorship of cancer in rural communities. Some examples are:

  • Less Access to Care: Cancer preventative care, screenings, treatment, and follow-up require a lot of appointments.4 But there is a shortage of cancer clinics and cancer specialists in rural areas. Only 5.6% of U.S. oncologists practice in rural areas, where 15% of Americans live.45
  • Higher Risk Factors: 67 Rural residents have higher percentages of important risk factors for cancer, like smoking8 and obesity.9
  • Less Access to Behavioral Resources:1011 In rural areas it is harder to access resources for quitting smoking, physical activity, and healthy eating.671213
  • Financial Issues: The cost of getting cancer-preventing vaccines, such as the HPV vaccine, may be problem for some rural residents.
  • Cultural Differences: The stoicism and sense of hardiness10 present in rural cultures can make it less likely someone will seek preventative care.

Planning strategies

The following policy options have demonstrated success in reducing rural cancer rates.

CDC's Tips From Former Smokers educational campaign features stories of people who formerly smoked living with smoking-related health conditions. Since 2012, CDC estimates that at least a half million people who smoke cigarettes have quit for good because of the campaign.14 Spiritual leaders and places of worship have played an important role in addressing social challenges and protecting people who are at risk.1015 The campaign provides a range of resources for faith-based communities and leaders.16

Human papillomavirus (HPV) vaccination protects against cancers caused by HPV infection,17 but vaccination rates for children are lower in rural areas.3 One significant barrier to HPV vaccination in rural areas is cost,18 especially since rural residents are less likely to be insured. 3Policies like the Federal Vaccines for Children Program have expanded access to many vaccines at a reduced out-of-pocket cost. Reducing out-of-pocket costs by paying for vaccinations, providing insurance coverage, or reducing copayments increases vaccination rates in rural areas.19

Colorectal cancer is the second leading cancer killer in U.S. adults.20But colonoscopies may be difficult for rural patients to schedule because they require a day of preparation, access to a colonoscopist, and someone to drive the sedated patient home.2122 One option to consider is a stool test when discussing screening options. It can be done in a patient's home via a mail-in kit.23 If the test indicates potential cancer, a follow-up colonoscopy can then be scheduled. The use of stool test kits has been shown to raise screening rates.24

Even after receiving a cancer diagnosis, rural residents are less likely to seek early-stage treatment and necessary follow-up care, resulting in a higher likelihood of death.10 Provider shortages in rural areas and lack of transportation play a key role in rural resident cancer deaths. State Rural Transit Assistance Programs (RTAPs)25 provide community leaders with workshops, on-site training, educational materials, and peer assistance to help them develop public non-emergency medical transit programs.

Rural cancer prevention case studies

The Southern Coalfields Tobacco Prevention Network in West Virginia provides tobacco-use policy guidance and prevention programs to a network of schools in six county coalitions. The guidance focuses on the unique needs of West Virginia populations who use tobacco the most, such as coal miners. For example, the network's Spit It Out program offered tobacco cessation services for hundreds of smokeless tobacco users and resulted in five workplaces going tobacco-free.

Accountable Care Organizations (ACOs) are networks of health care providers who share responsibility for providing patient care. ACOs create financial incentives to cooperate, share information, and save money, while providing coordinated, high-quality care to their Medicare patients.29 In Nebraska, a rural primary care ACO leveraged the incentives to promote colorectal cancer screenings. They used electronic health records and team-based care providers to identify patients eligible for and in need of screening. They then made sure the patients completed the procedures. This helped them to more effectively promote colorectal cancer screenings at lower costs.

In rural Idaho, a clinic raised its colorectal cancer screening rates from 52% to 69% by:

  • Gathering baseline data.
  • Sending electronic and mail reminders to patients.
  • Using appointments and public health events to promote screenings.
  • Utilizing stool tests, if indicated, for patients without insurance coverage.
  • Encouraging competition between clinic providers on their screening rates.

Hispanic women have higher rates of cervical cancer than any other ethnic group in America, yet often lack Spanish-speaking health care providers. In rural Georgia, the Salud es Vida (Health is Life) program targeted female Hispanic farmworkers. The program educated lay health workers (promotoras) about cervical cancer and the HPV vaccine that can prevent it. After receiving the information, the promotoras became more willing to be screened. They filled a critical gap by promoting screening and vaccines to others in their communities.


Rural Health Policy Briefs‎

This Public Health Strategies for Cancer Policy Brief is part of a series of CDC's Morbidity and Mortality Weekly Reports on rural health. CDC policy briefs provide a summary of evidence-based best practices or policy options for a public health issue.
  1. Moy E, Garcia MC, Bastian B, et al. Leading Causes of Death in Nonmetropolitan and Metropolitan Areas — United States, 1999–2014. MMWR Surveill Summ 2017;66(No. SS-1):1–8. DOI:
  2. American Cancer Society. (2017). Economic Impact of Cancer. Retrieved from
  3. Henley SJ, Anderson RN, Thomas CC, Massetti GM, Peaker B, Richardson LC. Invasive Cancer Incidence, 2004–2013, and Deaths, 2006–2015, in Nonmetropolitan and Metropolitan Counties — United States. MMWR Surveill Summ 2017;66(No. SS-14):1–13. DOI:
  4. American Society of Clinical Oncology. (2016). The State of Cancer Care in America, 2016: A Report by the American Society of Clinical Oncology. J Oncol Pract 12(4): 339-383.
  5. Centers for Disease Control and Prevention. (2017). About Rural Health. About Rural Health | Rural Health | CDC
  6. Steele CB, Thomas CC, Henley SJ, et al. Vital Signs: Trends in Incidence of Cancers Associated with Overweight and Obesity — United States, 2005–2014. MMWR Morb Mortal Wkly Rep 2017;66:1052–1058. DOI:
  7. Henley SJ, Thomas CC, Sharapova SR, et al. Vital Signs: Disparities in Tobacco-Related Cancer Incidence and Mortality — United States, 2004–2013. MMWR Morb Mortal Wkly Rep 2016;65:1212–1218. DOI:
  8. National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention (US); 2014. Available from:
  9. Lauby-Secretan, B., Scoccianti, C., Loomis, D., Grosse, Y., Bianchini, F., & Straif, K. (2016). Body fatness and cancer—viewpoint of the IARC Working Group. New England Journal of Medicine, 375(8), 794-798.
  10. Crosby, R. A., et al. (2012). Rural Populations and Health: Determinants, Disparities, and Solutions, John Wiley & Sons.
  11. Matthews KA, Croft JB, Liu Y, et al. Health-Related Behaviors by Urban-Rural County Classification — United States, 2013. MMWR Surveill Summ 2017;66(No. SS-5):1–8. DOI:
  12. Rural Health Information Hub. Reducing Out-Of-Pocket Costs for Evidence-Based Cessation Treatments. (2014). Retrieved from
  14. Centers for Disease Control and Prevention. (2017). Tips From Former Smokers – About the Campaign. Retrieved from
  15. Centers for Disease Control and Prevention. (2017). Faith-Based FAQs.
  17. Centers for Disease Control and Prevention. (2017). HPV Vaccines: Vaccinating Your Preteen or Teen. Retrieved from
  18. Ferrer, H. B., et al. (2014). Barriers and facilitators to HPV vaccination of young women in high-income countries: a qualitative systematic review and evidence synthesis. BMC Public Health 14(1): 700.
  19. Jacob, V., et al. (2016). Increasing Coverage of Appropriate Vaccinations: A Community Guide Systematic Economic Review. Am J Prev Med 50(6): 797-808.
  20. Kochanek, K. D., Murphy, S. L., Xu, J., & Tejada-Vera, B. (2016). Deaths: final data for 2014. National vital statistics reports: from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, 65(4), 1-122.
  21. Knudsen AB, Zauber AG, Rutter CM, Naber SK, Doria-Rose VP, Pabiniak C, Johanson C, Fischer SE, Lansdorp-Vogelaar I, Kuntz KM. Estimation of Benefits, Burden, and Harms of Colorectal Cancer Screening Strategies Modeling Study for the US Preventive Services Task Force. JAMA. 2016;315(23):2595–2609.
  22. Anderson, A. E., et al. (2013). Rural vs urban residence affects risk-appropriate colorectal cancer screening. Clin Gastroenterol Hepatol 11(5): 526-533.
  23. Centers for Disease Control and Prevention. (2017). Colorectal Cancer Screening Tests. Retrieved from
  24. Charlton, M. E., et al. (2014). Evaluation of a home-based colorectal cancer screening intervention in a rural state. J Rural Health 30(3): 322-332.
  25. Rural Health Information Hub. (2017). Transportation to Support Rural Healthcare. Retrieved from
  26. Rural Health Information Hub. Southern Coalfields Tobacco Prevention Network. Retrieved from
  27. Rural Health Information Hub. (2017). Spit It Out-West Virginia. Retrieved from
  28. Kim, J., et al. (2017). Promoting colorectal cancer screening through a new model of delivering rural primary care in the USA: a qualitative study. Rural and Remote Health 17(4187).
  29. Centers for Disease Control and Prevention. Partnering With Accountable Care Organizations for Population Health Improvement. Retrieved from
  30. Miller Temple, K. (2017). “Doing Something Exceptional”: Rural Communities and Colorectal Cancer Screening, Rural Health Information Hub.
  31. Rural Health Information Hub. (2017). Salud es Vida Cervical Cancer Education. Retrieved from
  32. Luque, J. S., et al. (2011). Salud es vida: development of a cervical cancer education curriculum for promotora outreach with Latina farmworkers in rural Southern Georgia. Am J Public Health 101(12): 2233-2235.