Cancer survivors who live in rural areas of the United State are more likely to say they are in poor health than those who live in urban areas, according to new research from Wake Forest Baptist Medical Center in Winston-Salem, N.C.Also, rural residents are less likely to follow cancer screening recommendations than Americans who live in urban areas, according to other researchers, from Huntsman Cancer Institute (HCI) at the University of Utah. There, scientists determined that differences stemming from where people live are evident across all cancer-risk groups, including those who have a family history of the disease.“Our hypothesis was that geography matters,” said Anita Kinney, a Ph.D. and Registered Nurse who leads HCI’s Cancer Control and Populations Sciences Research Program and is principal investigator of the study.“What we found is that it does, indeed, matter,” she added.“Other studies have confirmed differences in health-care behaviors between urban and rural residents,” she continued. “Ours is the first study to examine the influence of distance from, and availability of, screening providers on the use of risk-appropriate screening among urban and rural dwellers.”Besides location and the necessity to travel to health providers, rural cancer survivors are more likely to have lower incomes, have less education, and lack health insurance – all factors which may add to additional stress, too.So, rural Americans are more likely to have psychological distress as well as other health disorders. In addition, rural Americans are more likely to be unemployed due to health reasons than city dwellers, according to the study, which was published in the journal Cancer.This situation is more than the inconvenience of getting to health providers, who locate less often in small towns. There’s the time commitment for patients and their families, as well.“One fact that gets overlooked in addressing compliance with screening recommendations is the amount of time required for a person to obtain the appropriate screening,” said co-author Kevin Henry, Ph.D., an HCI investigator and assistant professor in the Department of Geography at the University of Utah. “With the longer distance traveled, a person may need to set aside a day or more from regular activities for preparations and travel as well as the procedure itself.”Another problem, according to the researchers, is that rural people are less likely than urban residents to even receive a recommendation from a health-care provider for screenings, such as a colorectal cancer (CRC) exam. That also may be due to primary-care provider shortages and time constraints felt by the medical professionals, too.“We know that CRC screening saves lives,” Kinney said. “The more people are screened, the more lives we save.”Other problems for rural residents may compound problems with diagnoses, treatment and recovery from cancer, the researchers said. A major dilemma is that rural residents are less likely to have health insurance that pays for cancer screening.“If you think of the stress of cancer and not being able to afford and access health care, I am sure that that amplifies stress for them,” said lead author Kathryn E. Weaver, Ph.D., an assistant professor at Wake Forest.Unemployment or under-employment may also add stress and interfere with getting health care, since most people below retirement age in the United States get their health insurance through their employers, she added.However, Kinney pointed out that “preventive services such as cancer screening are covered in the Affordable Care Act [health care reform – “Obamacare”], and this should increase the number of people who get regular screening.”The Wake Forest study, from a survey of almost 8,000 cancer survivors, shows that there are “an estimated 2.8 million cancer survivors in rural areas of the United States,” Weaver said.- Contact Bill at; columns archived at