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An official government map shows America's biggest hotspots for young cancer patients.
The data comes amid a nationwide surge of the disease in Americans under 50, even those who appear relatively fit and healthy.
The map, based on the latest 2021 data from the National Cancer Institute, shows the rates of cancer incidences per 100,000 residents under age 50.
The figures were collected from over 2,500 US counties, though there was missing data for Kansas and Indiana.
Rounding out the top five were all rural counties in the South and Midwest.
Union County, Florida, had the highest rate of early-onset cancer, with 430 cases per 100,000 people.
Southwest of Jacksonville, the rural area with just 15,000 residents has historically led the country in lung, oral, colorectal, and skin cancers.
Health officials believe this could be due to high smoking rates and a lack of health care funding in the area, as well as one in six residents living in poverty.
Poverty is linked to poor diet, poor sleep, high alcohol consumption and other factors that raise the risk of cancer.
Fisher County, Texas, had the second-highest rate at 213 per 100,000 residents, with additional data suggesting that this could be blamed on one in five residents not having health insurance, meaning they could be more likely to ignore preventative screenings.
Rural counties in Nebraska, Arkansas, and West Virginia rounded out the top five.
Meanwhile, Currituck County, North Carolina, had the lowest rate of cancer in under-50s, which could be due to having a higher household income than the national average and a more urban population that counties with higher rates.
Despite rates of chronic diseases like diabetes being up to 35 percent higher than the national average, the border community ranks below the national average in lung, bronchus, and breast cancer, according to state health data.
Union County's high rates could be due to its combination of poor health outcomes.
According to a recent report from the Institutes for Health Metrics and Evaluation, Union County is the least healthy county in the US overall.
The data found that the small are leads US deaths in HIV/AIDS and tuberculosis.
In terms of cancer, the area ranked two to six times higher than the national rates for tracheal, bronchus, lung, kidney, livre, oral, colorectal, testicular, and pancreatic cancers.
The county's life expectancy is also just 67 years, well below the national average of 76, according to US News and World Report.
In 2014, Joe Pietrangelo, health officer at Union's County's health department, said the department suffered a consistent lack of funding, which prevented it from offering services like screenings to vulnerable residents.
Census Data from 2022 also shows that 16 percent of residents live in poverty, 25 percent more than the national average of 12.5 percent.
The following map shows the rate of cancers in people under 50 in over 2,500 US counties
Fisher County, Texas, had the second-highest rate of cancer in under-50s. Though the area's 16.5 percent smoking rate is about 13 percent lower than the national average, 17.6 percent of residents don't have health insurance. This could prevent them from keeping up with preventative screenings like colonoscopies.
Thayer County, Nebraska, rounded out the top three, accounting for 204 cases per 100,000 people. With just 3,600 residents, one in 10 live in poverty, according to Census data.
Surrounded by wide areas of farmland, pesticide use in Nebraska could also contribute to high cancer rates in young people. A 2019 report from environmental group Green Matters, for exmaple, found that Nebraska had the third-highest use of the herbicide glyphosate, behind Illinois and Iowa.
While the Environmental Protection Agency (EPA) believes the chemical 'is unlikely to be a carcinogen,' research has widely debated the topic. The International Agency for Research on Cancer, an arm of the World Health Organization, however, classified it as 'probably carcinogenic to humans.'
Woodruff County, Arkansas, and Webster County, West Virginia took the fourth and fifth highest spots, with 191 and 184 cases per 100,000 people, respectively.
Experts suggest that high rates in these areas could be due to low household income, high poverty rates, and increased use of pesticides
On the flip side, Currituck County, North Carolina, had the lowest incidence, with 55 cases per 100,000 people. With 28,100 residents, the NCI classifies this county as 'urban.'
The lower rates could be due to the household income, which is just under $83,000, about 10 percent above the national average of $74,000. Additionally, just 8.5 percent of residents live in poverty compared to the national average of 12.5 percent.
These factors could raise the likelihood of residents being able to afford health insurance, screening, and doctor visits, lowering their risk of developing cancer at as young age.