Modern oncology labs perform miracles every day. In major teaching hospitals, doctors can sequence a patient’s tumor genome in less than a week, identify the specific genetic mutations driving the disease, and write a prescription targeted to a single aberrant cellular pathway.
But for millions of Americans, one of the most important factors in surviving cancer remains decidedly low-tech: where they live.
Out past the suburbs, prostate cancer care doesn’t break down at the cellular level. It breaks down on the road. We are investing billions in making cancer treatment more precise while too many patients still can’t reliably reach the healthcare system delivering it. That should trouble all of us.
I see this crisis through two distinct lenses. Professionally, I lead a national cancer advocacy organization. Personally, I am a 20-year cancer survivor and a caregiver walking alongside my father while he navigates prostate cancer. I know the sheer panic that accompanies this diagnosis under the best possible circumstances. But when your geography works against you, that burden turns overwhelming.
Healthcare equity conversations in the United States have often centered on race. Black men face an unconscionable burden: they are nearly twice as likely to be diagnosed with prostate cancer and twice as likely to die from it compared to white men. What rarely makes the evening news is how race collides directly with geography.
Picture a man living in a rural farming county. Catching prostate cancer early does not demand a multi-million-dollar imaging center. It requires an annual routine checkup and a basic blood test to check his prostate-specific antigen (PSA) levels. That sounds straightforward. For millions, it isn’t. Over 60% of federally designated primary care shortage areas sit squarely in rural counties. In fact, more than 7% of U.S. counties lack a single practicing family doctor. For this man, getting routine bloodwork drawn means taking a full day off work, burning through gas he might not be able to afford, and driving two hours round-trip just to sit on an exam table. If that blood test shows an elevated PSA, his situation worsens.
He needs a specialist. But more than 60% of all U.S. counties have no practicing urologist. While a man in suburban Philadelphia or Chicago travels less than 10 miles to see a specialist, a rural patient drives an average of 50 miles each way. When small-town doctors retire, nobody steps in to take over their practices. The medical desert just gets wider. Distance changes medical decisions. It changes who lives and who dies.
Consider the numbers from a Pennsylvania study tracking more than 51,000 prostate cancer patients: rural men were 23% less likely to receive treatment for low-risk disease, 29% less likely for intermediate-risk disease, and 32% less likely for high-risk disease than their urban counterparts. That disparity remained even after researchers controlled for age, overall health, and clinical tumor stage. When advanced tissue-based biomarker testing became standard practice in metro cancer centers, giving oncologists the power to target aggressive tumors with precision therapies, rural Medicare patients were 18% less likely ever to receive that testing. Geography decided their treatment, not biology.
Black men in rural communities stand at the most dangerous intersection of this failure. They are forced to navigate severe medical shortages alongside generations of structural neglect. A mobile van rolling into a town square once a year will not fix that. Real change requires showing up where people live, work, and worship — and staying there.
Laboratory breakthroughs cannot save lives if patients cannot reach them. A patient’s five-digit ZIP code must never determine whether they survive prostate cancer. We have engineered the breakthroughs; now it is time to build the road.
Photo: Ann Cutting, Getty Images
Courtney Bugler is President and CEO of nonprofit ZERO Prostate Cancer, bringing more than 15 years of leadership experience across cancer advocacy, health equity, and nonprofit strategy, including executive roles at Susan G. Komen, JDRF International, and the Young Survival Coalition.
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