Invisible geographies - the rural and coastal blind spot in UK cancer policy: A content analysis

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BACKGROUND: The United Kingdom's (UK) diverse geography means many people live in rural and coastal areas, where cancer outcomes are often poorer than in urban settings. Devolution means that the four nations of the UK have distinct approaches to cancer care. Scotland, Wales, and Northern Ireland have recently published national cancer strategies, while England's new plan is expected later in 2025. This study examined UK cancer policy documents, to identify, how, and to what extent, rural or coastal issues were considered. METHODS: UK cancer policy documents from 2000 to 2024 were sourced via The International Cancer Control Partnership (ICCP) website (https://iccp-portal.org/), UK government sites and Google. Documents were searched for rural and coastal related terms. RESULTS: Fifty-five documents were included (England n = 17; Northern Ireland n = 10; Scotland n = 21; Wales n = 7). No recent policies included a specific section or explicit recommendations for rural or coastal cancer care. Across the policies, contextual analysis highlighted that terms to promote rural or coastal equity rarely appeared within recommendations. Northern Ireland gave more attention to rural issues than other nations, as evidenced by a rural needs impact assessment and supporting documents to inform Northern Ireland's Cancer Strategy 2022-2032. CONCLUSION: Despite sizeable rural and coastal populations facing specific health challenges across the UK, national cancer policies excepting Northern Ireland gave minimal guidance for delivering cancer care tailored to these communities. Other UK nations should consider adopting more rural-centric approaches like Northern Ireland. POLICY SUMMARY: Coastal and rural health issues have received policy attention via the Chief Medical Officer for England's annual reports (2021; 2023) and more recently in the UK Government's 10 Year Health Plan for England (July 2025). However, when it comes to high-level cancer policy across the UK, the needs of rural and coastal people with cancer are not being adequately or specifically recognised.

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