Rural-urban disparities in head and neck cancer

Existing research has shown a higher rural than urban mortality for head and neck cancers.

In a new paper in Oral Oncology, University of Michigan Health researchers explicated these trends, examining differences in outcomes in urban and rural settings for different kinds of cancer, including larynx, oral  cavity and oropharynx.

Senior author David W.A. Forner, M.D., M.Sc., Clinical Assistant Professor of Otolaryngology-Head and Neck Surgery at the University of Michigan Medical School, discusses their findings in this Q&A.

What are the main findings of this latest paper?

Forner: This study found that patients with head and neck cancer who live in rural areas have a higher mortality rate compared to those living in urban areas.

This difference is getting worse over time and also differs by where in the head and neck the cancer is located.

To what extent do these differences reflect different rates of improvement (e.g., urban patients having quicker access to innovations) versus a worsening of results in rural areas?

Forner: Both mechanisms (different rate of improvement and worsening rural mortality) are likely to be at play, as evidenced by our subsite analyses.

Overall, there appears to be a worsening of age adjusted mortality amongst patients living in rural areas.

This is compared to a relatively constant age adjusted mortality for patients living in large metro areas.

While urban patients may or may not have quicker access to specialized health care and innovations, these results suggest there are additional factors impacting rural patients.

Oropharyngeal cancer mortality was previously similar in urban and rural areas. Now it’s much higher in rural areas. What do you think caused the change?

Forner: The difference may be driven by cases associated by human papillomavirus and differences in smoking and other risk factor exposure.

This is a unique area of future research.

When these disparities are broken down by specific subsites, which subsite seems easiest to address in the short term? Which subsite disparity will be hardest to address?

Forner: It is difficult to know which subsite is the easiest to address in the short term as they all have their own unique considerations and hypotheses as to what is creating the rural-urban disparity.

This current study generates a lot of future questions.

Oropharyngeal cancer is the most common head and neck cancer and reducing the disparity may have the greatest impact.

Sign up for Health Lab newsletters today. Get medical tips from top experts and learn about new scientific discoveries every week.

Sign up for the Health Lab Podcast. Add us wherever you listen to your favorite shows.