Rurality and Income on Breast Cancer Outcomes: An Analysis of the SEER Database.
Suniah Ayub1, Angelo Marra2, Yuan Liu2
1Department of Surgery and Winship Cancer Institute, Emory Winship Cancer Institute at ESJH, Emory University, Atlanta, GA, USA. sayub@emory.edu.
Annals of Surgical Oncology
|February 19, 2026
Summary
Breast cancer patients in rural, lower-income settings face disparities in diagnosis and treatment compared to urban counterparts. Understanding the complex interaction between rurality and income is crucial for addressing these health inequities.
Area of Science:
- Oncology
- Health Disparities Research
- Epidemiology
Background:
- Breast cancer outcomes vary significantly based on socioeconomic status and geographic location.
- Limited research exists on the combined impact of rurality and income on breast cancer patient outcomes.
- National-level data are needed to understand these complex interactions.
Purpose of the Study:
- To investigate the interaction between residential rurality and income level on breast cancer clinical presentation and treatment patterns.
- To identify disparities in breast cancer care associated with the intersection of rural and lower-income status.
- To provide data for future interventions aimed at reducing breast cancer inequities.
Main Methods:
- Utilized the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program (2004-2020) for breast cancer diagnoses.
- Classified patient location as rural or urban using SEER's Rural-Urban Continuum Codes.
- Defined income as lower (≤ $55,000) or higher (> $55,000) and stratified data by rurality and income.
Main Results:
- Of 815,220 cases, 57,063 were rural lower-income (RLI), 55,667 urban lower-income (ULI), 29,762 rural higher-income (RHI), and 672,728 urban higher-income (UHI).
- RLI patients were more likely diagnosed with localized disease and were older at diagnosis compared to ULI patients.
- ULI patients exhibited higher rates of estrogen receptor-negative and HER2-positive disease, and received more lumpectomies, chemotherapy, and radiation compared to RLI patients.
Conclusions:
- Both income level and residential setting are independently associated with disparities in breast cancer clinical presentation and treatment.
- The interplay between rurality and income significantly influences breast cancer outcomes and requires further investigation.
- Understanding the geospatial distribution of these disparities is essential for developing targeted interventions.
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