Background: Cancer incidence and mortality rates in the United States are declining,
but this decrease may not be observed in rural areas where residents are more likely
to live in poverty, smoke, and forego cancer screening. However, there is limited
research exploring national rural-urban differences in cancer incidence and trends.Methods:
We analyzed data from the North American Association of Central Cancer Registries'
public use dataset, which includes population-based cancer incidence data from 46
states. We calculated age-adjusted incidence rates, rate ratios, and annual percentage
change (APC) for: all cancers combined, selected individual cancers, and cancers associated
with tobacco use and human papillomavirus (HPV). Rural-urban comparisons were made
by demographic, geographic, and socioeconomic characteristics for 2009 to 2013. Trends
were analyzed for 1995 to 2013.Results: Combined cancers incidence rates were generally
higher in urban populations, except for the South, although the urban decline in incidence
rate was greater than in rural populations (10.2% vs. 4.8%, respectively). Rural cancer
disparities included higher rates of tobacco-associated, HPV-associated, lung and
bronchus, cervical, and colorectal cancers across most population groups. Furthermore,
HPV-associated cancer incidence rates increased in rural areas (APC = 0.724, P < 0.05),
while temporal trends remained stable in urban areas.Conclusions: Cancer rates associated
with modifiable risks-tobacco, HPV, and some preventive screening modalities (e.g.,
colorectal and cervical cancers)-were higher in rural compared with urban populations.Impact:
Population-based, clinical, and/or policy strategies and interventions that address
these modifiable risk factors could help reduce cancer disparities experienced in
rural populations. Cancer Epidemiol Biomarkers Prev; 27(11); 1265-74. ©2017 AACR.