2025 US Cancer Disparities Report Highlights Education, Rural Gaps
Key Clinical Summary
- Cancer mortality disparities persisted in the US (2019–2023), with the highest overall rates in Black and American Indian/Alaska Native (AIAN) populations and in lower socioeconomic status (SES) groups.
- Education-level gaps were larger than race-level gaps: within each race, mortality was markedly higher among adults with ≤12 years vs ≥16 years of education.
- Rural–urban differences were substantial, with all-cancer mortality 21% higher in nonmetropolitan vs large metropolitan counties, driven most by lung (45%) and cervical (36%) cancer mortality.
The American Cancer Society’s (ACS’s) 2025 Report on the Status of Cancer Disparities in the United States documents persistent inequities across the cancer continuum—risk factors, screening, stage at diagnosis, treatment access, survival, and mortality—by race/ethnicity, education (as an SES proxy), and geography. Using national registry, survey, and mortality datasets, the report highlights that education and rural residence are major drivers of cancer outcome differences in the United States.
Report Findings
Across 2019–2023, Black and AIAN populations had the highest cancer mortality rates overall and for leading causes of cancer death, and mortality was consistently higher among adults with lower SES, measured by educational attainment. The report emphasizes that mortality differences were “substantially larger by education than by race,” suggesting SES plays a major role in racial disparities.
When comparing Black and White adults at the same education level, overall cancer mortality was higher in Black adults by 7% to 28% among males and 2% to 43% among females. Within each racial group, however, the gradient by education was far larger: adults with ≤12 years of education had higher overall cancer mortality than those with ≥16 years by 143% to 192% among males and 71% to 140% among females.
Geography also mattered. Mortality from all cancers combined was 21% higher in nonmetropolitan than large metropolitan counties, with the largest rural–urban gaps for lung cancer (45%) and cervical cancer (36%). By congressional district, the highest cancer mortality (overall and for lung, colorectal, and breast cancers) was largely concentrated in the South and East North-Central Midwest, while prostate cancer showed no distinct geographic pattern.
Clinical Implications
For clinicians, the report reinforces that cancer disparities are not limited to incidence; they extend to stage at diagnosis, treatment access, and survival, and they align closely with insurance coverage and social determinants of health (SDOH). Populations with higher mortality generally experienced higher exposure to modifiable risk factors, lower insurance coverage, and reduced access to prevention, early detection, and treatment.
The findings are particularly relevant for screenable cancers where mortality exceeds what incidence patterns might predict. For example, nonmetropolitan areas had higher mortality for several cancers, including breast and prostate, despite lower incidence, consistent with later diagnosis, limited specialist access, and treatment delays described in the report.
The report also highlights actionable care gaps: uninsured adults were more likely to delay or forgo care due to cost (30.8% vs 8.3% to 9.7% insured, 2024) and were less likely to be up to date with screening, including colorectal (76.5% not up to date vs 35.4% to 45.4%) and breast cancer screening (65.2% not up to date vs 26.3% to 36.7%). These patterns support clinic-level prioritization of navigation, insurance assistance, and targeted screening outreach—especially in rural and lower-education populations.
The report concludes that disparities across prevention through survivorship “largely reflect fundamental disparities in SDOH” and states that mitigating cancer disparities in the United States requires “intersectoral stakeholder engagement, targeted funding, and effective policies” at all levels. The authors specifically cite evidence-based interventions such as expanding health insurance coverage, including by strengthening Affordable Care Act (ACA) Marketplaces and protecting and expanding access to Medicaid.
Conclusion
The ACS 2025 cancer disparities report underscores that education-linked SES and rural residence are strongly associated with worse cancer outcomes across the United States. The authors call for coordinated policy and health system responses—particularly around insurance coverage, prevention, and equitable access to screening and treatment—to reduce avoidable cancer deaths.
Reference
Islami F, Arias G, Lee D, et al. American Cancer Society’s Report on the Status of Cancer Disparities in the United States, 2025. CA Cancer J Clin. 2026;76(1):e70045. doi:10.3322/caac.700.
