Do rural populations experience greater worry and fatalism about cancer?

Mayo Clinic Cancer Center is a National Cancer Institute-designated comprehensive cancer center, with campuses in Phoenix/Scottsdale, Arizona; Jacksonville, Florida; and Rochester, Minnesota. The center's catchment area includes 29 counties in five states with multiple rural areas. The team conducted a population-based survey of randomly selected households across the three regions of the Mayo Clinic Cancer Center catchment area, receiving 1,157 completed responses.

"Survey respondents who live in the rural areas were more likely to agree with statements such as 'It seems like everything causes cancer,' 'There is not much you can do to lower your chances of getting cancer,' and 'There are so many different recommendations about preventing cancer, it's hard to know which ones to follow,' says Kristin J. Harden, M.P.H., a health services researcher at Mayo Clinic and the study's lead author. "They were also more likely to respond 'extremely' to the question 'How worried are you about getting cancer?'"

Even though the team controlled for social and demographic variables, such as education, race and ethnicity, and health insurance status; they found that in general, people living in rural areas preferred not to know what their risk of developing cancer was.

What you don't know can't hurt you ...

In this instance at least, a lack of knowledge could be deadly. "Having these kinds of pessimistic beliefs towards cancer prevention may discourage participation in cancer prevention and screening, which could contribute to health disparities," says Harden.

Recent reports indicate that both the incidence rates of cancer, as well as cancer-related deaths, are decreasing in the U.S. However, in rural areas, observed declines are slower. In fact, Harden says, "this is particularly true for cancers that can be prevented through behavior change, such as stopping smoking or participating in evidence-based cancer screenings such as colonoscopy."

"Public health researchers and health care professionals working in rural areas need to understand these attitudes, as well as the variability across the different communities they work in," she says.

"Interventions that work in one community may not work in another. Therefore, professionals developing potential interventions should do so in collaboration with community members to ensure alignment with individual community needs and values."

Collaboration and continued research

The research team hopes to expand on these findings, collaborating with rural community members to help better understand the findings and collect ideas that could lead to customized interventions for different communities.

"This research is directly responsive to NCI priorities, both with its focus on catchment area and on rural populations," says study senior author Lila Finney Rutten, Ph.D., M.P.H., Professor of Health Services Research in the Mayo Clinic College of Medicine and Science; and the Robert D. and Patricia E. Kern Scientific Director for Population Health Science, in the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.

"We expect these findings to inform our continued research in Mayo Clinic Cancer Center, as well as to improve our ability to better engage with and care for our rural populations," says Dr. Rutten.