Rural Issues: Health disparity in rural America

Fall is my favorite season. The crisp morning air, farmers harvesting corn and soybean fields, bonfires, FFA contests, Friday night lights, trees exploding with brilliant red, purple, orange and yellow leaves, fall festivals and other activities featuring pumpkins, mums, apple cider and music — I’m all in!

October is a big birthday month in my family and my parents celebrated 64 years of marriage on Oct. 5. October is Breast Cancer Awareness Month and we celebrate so many of our friends and family that have survived breast cancer.

According to the National Cancer Institute, “Death rates for the leading causes of cancer death — lung, colorectal, pancreatic and breast cancers — are higher in rural areas. Disparities in death rates between rural and urban areas are particularly large for lung cancer and relatively small for breast and pancreatic cancers. Evidence suggests that progress in reducing cancer death rates for all cancers combined and for most common cancers has been slower in rural than in urban areas, further widening the disparity in mortality.

“Breast, lung and bronchus, prostate and colorectal cancers are the most common cancers in both rural and urban areas in the United States, accounting for almost half of all new cancer cases.”

People in rural areas also face the challenge of access to health care. There are fewer primary care healthcare providers and fewer specialty-care providers in rural communities than in urban areas.

In the past decade, hospitals in two of our neighboring counties — where the largest towns have populations of between 5,000 and 8,000 residents — have been shuttered.

Larger hospital and healthcare systems have begun to offer services one or two days per week in these counties, but most of the follow-up testing and treatment of a cancer diagnosis must be done elsewhere. For many, that elsewhere is at least an hour or more away.

The National Cancer Institute confirms that although an estimated 17% to 20% of the U.S. population resides in rural areas, more than 70% of counties in the United States do not have medical oncologists. As a matter of fact, only 3% of the doctors of oncology practice in rural communities.

Because there are fewer providers where many of us live, there is less likelihood that rural residents will have ease of access to cancer screening. Those who are diagnosed with this terrible disease have access to a lower quality of cancer care in rural areas.

Couple the aforementioned complications with a lower income level, lack of insurance and less awareness of cancer risks and the benefits of cancer screening and there is an even greater cause for concern. Rural women are overall less likely to have been screened for breast cancer and cervical cancer than women in urban areas.

Yet another complication is the potential for diagnoses to be delayed. If a mammogram is abnormal, an MRI or sonogram might need to be performed, followed by a biopsy. These all take time in an urban setting.

Throw in decreased access to resources and greater distance to medical services and the potential for delayed diagnosis and treatment is inevitable.

The days of the local doctor making house calls in the country are long gone. For many, access to health care isn’t easy and so it is put off. Please, don’t delay.

Make the appointment and have the mammogram, or the colonoscopy. Early diagnosis is the best path to a positive outcome.