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How much does where your patients live affect their cancer risk? Apparently a lot. While the mechanisms are complex, studies show geography affects a number of factors that can lead to higher incidence and worse outcomes of various cancer types. 

Rural living is one of the many contexts in which geography affects risk. While rural populations are some of the least studied in terms of cancer risk, they maintain some of the highest rates. Why does this disparity exist?

The primary reasons are related to access. Unlike urban populations, rural dwellers often lack proximity to hospitals and consequent screenings, treatments, and the like. Studies have shown that those with longer travel times face later diagnoses and consequently higher mortality rates; and in one study conducted in Northern England, cancer services were actually found to be located farther from regions with the most cancer cases. Rural populations may be further impacted by influences of culture, including diet or conflicting opinions on healthcare, or work in environments with high exposure to carcinogens, which all can correlate to an increase of risk.

This is not to say that urban populations are immune to cancer risk; in actuality, many urban dwellers face similarly dangerous outcomes for very different reasons. Those living in cities are placed in much higher proximity to toxic environments, including air pollution and toxic industrial waste. More often than not, socioeconomic status and related marginalization, racial or otherwise, forces people into these toxic environments. 

Geography can also impact access to health insurance. Because Medicaid coverage varies by state, the state a patient lives in can affect cancer risk; this came to light in Tennessee, where cuts to Medicaid led to delayed treatments and later diagnoses for breast cancer. Even within a state, different cities with differing policies or degrees of social issues (i.e. racism) may face varied risk.

In order to reduce the effects of geographic location on cancer risk, it may be beneficial to increase outreach and cancer screening for vulnerable populations; further, more studies must be done to gain a holistic understanding of geographic factors in order to enact policy change.

Written by Robin Baumeister

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