Common Cancers in Metropolitan and Non-metropolitan Counties

Introduction

Cancer is the second leading cause of death in the United States, surpassed by heart disease. From 2018 to 2022, there were more than 9 million new cancer cases (incidence) and 3 million deaths (mortality). The most common cancer types for both incidence and death rates (new cases or deaths per 100,000 people) during these years were female breast, prostate, lung and bronchus (lung), and colon and rectum (colorectal). These cancer types made up 48% of the total number of cancers diagnosed and 44% of cancer deaths from 2018 to 2022.

About 14% of people in the United States lived in non-metropolitan (rural) counties during 2018 to 2022. CDC data show they may face health disparities compared with residents of metropolitan (urban) counties. This report examines cancer incidence and death rates by county-level urbanicity defined in the 2013 Rural-Urban Continuum Codes from the U.S. Department of Agriculture.

It is important to note that rates may be lower in this 5-year period than in other 5-year periods due to the COVID-19 pandemic.

Variations in cancer incidence rates by sex and urbanicity

Female breast cancer incidence rates were higher among women in metropolitan counties than in non-metropolitan counties. Similarly, prostate cancer incidence rates were higher among men in metropolitan counties than in non-metropolitan counties. In contrast, lung and colorectal cancer incidence rates were lower among men and women in metropolitan counties than in non-metropolitan counties. The rates are displayed from the highest incidence to the lowest incidence among the four most common cancer types in Figure 1.

Figure 1. Incidence rates^a for the most common cancer types by sex and urbanicity, United States, 2018–2022^b

Variations in cancer incidence by sex, age group, and urbanicity

Incidence rates for each cancer type generally increased as age increased. Incidence rates of both lung and colorectal cancers were highest in men and women aged 75 years or older. However, female breast cancer and prostate cancer incidence rates were highest among those aged 65 to 74 years. For each age group, incidence rates for breast and prostate cancer were higher among those who lived in metropolitan counties than those in non-metropolitan counties, while incidence rates for lung and colorectal cancers were higher among those who lived in non-metropolitan counties than in metropolitan counties. (Figure 2).

Figure 2. Incidence rates^a for the most common cancer types by sex, age, and urbanicity, United States, 2018–2022^b

Variations in cancer death rates by sex and urbanicity

Deaths for each of the common cancer types was higher in non-metropolitan counties than in metropolitan counties, and higher among men than women. The highest death rate was seen in lung cancer among men in non-metropolitan counties. Around 80% to 90% of lung cancer deaths are caused by cigarette smoking in the U.S.

Figure 3. Death rates^a for the most common cancer types by sex and urbanicity, United States, 2018–2022^b

Variations in cancer death rates by sex, age, and urbanicity

Cancer death rates increased with age, and in each age group, rates were higher among those in non-metropolitan counties than in metropolitan counties. The highest death rate was for lung cancer among men aged 75 years or older in non-metropolitan counties (377.6 deaths per 100,000 standard population).

Figure 4. Death rates^a for the most common cancer types by sex, age, and urbanicity, United States, 2018–2022^b

For some cancer types, people who live in non-metropolitan counties may have higher incidence and death rates than people in metropolitan counties because of limited access to resources for cancer prevention, screening, treatment, and survivorship. Local public health programs can implement initiatives to guide their communities toward better health.

Footnotes

^a New cancer cases or deaths per 100,000 standard population. Rates were age-adjusted to the 2000 U.S. standard population.

^b The COVID-19 pandemic disrupted health services, leading to delays and reductions in cancer screening and diagnosis, which may have contributed to lower incidence for most cancer sites in 2020. For more information, see Impact of COVID-19 on SEER Data Releases.

Data source

Data in this brief come from U.S. Cancer Statistics, the official federal cancer statistics. U.S. Cancer Statistics incidence data are from population-based registries that participate in CDC's National Program of Cancer Registries (NPCR), the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program, or both programs and have met high-quality data criteria for data submitted in 2024, covering 100% of the U.S. population. The most current incidence data available during this time are cancer cases diagnosed in 2022. State but not county-level cancer incidence data are available from Kansas. U.S Cancer Statistics death data are from CDC's National Center for Health Statistics National Vital Statistics System and cover 100% of the U.S. population.