Receipt of Cancer Screening Services: Surprising Results for Some Rural Minorities

University of South Carolina School of Medicine, Department of Family & Preventive Medicine, Columbia, South Carolina, USA.
The Journal of Rural Health (Impact Factor: 1.45). 12/2012; 28(1):63-72. DOI: 10.1111/j.1748-0361.2011.00365.x
Source: PubMed


Evidence suggests that rural minority populations experience disparities in cancer screening, treatment, and outcomes. It is unknown how race/ethnicity and rurality intersect in these disparities. The purpose of this analysis is to examine the cancer screening rates among minorities in rural areas.
We utilized the 2008 Behavioral Risk Factor Surveillance System (BRFSS) to examine rates of screening for breast, cervical, and colorectal cancer. Bivariate analysis estimated screening rates by rurality and sociodemographics. Multivariate analysis estimated the factors that contributed to the odds of screening.
Rural residents were less likely to obtain screenings than urban residents. African Americans were more likely to be screened than whites or Hispanics. Race/ethnicity and rurality interacted, showing that African American women continued to be more likely than whites to be screened for breast or cervical cancer, but the odds decreased with rurality.
This analysis confirmed previous research which found that rural residents were less likely to obtain cancer screenings than other residents. We further found that the pattern of disparity differed according to race/ethnicity, with African Americans having favorable odds of receipt of service regardless of rurality. These results have the potential to create better targeted interventions to those groups that continue to be underserved.

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    • "Although colorectal cancer screening rates have increased over time, increases have been lower in those who are less educated, have a lower income, lack health insurance, and are Hispanic [4] [5]. Analysis of the 1999 and 2008 BRFSS showed that rural residents were also less likely to receive recommended colorectal cancer screening than their urban counterparts [6] [7]. While socioeconomic status (education and income) may directly predict cancer-screening behavior, CRC risk is also influenced by several behaviors other than screening. "
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    ABSTRACT: Colorectal cancer (CRC) ranks second for all cancer related deaths among men and women together and third for either sex when considered separately. Disparities exist in CRC incidence and mortality between rural and urban counties in the USA. This study sought to explore socioeconomic and behavioral factors that may partly explain these observed differences. Using educational and income levels as our measures of socioeconomic status (SES), and average alcohol consumption and smoking frequency as our behavioral factors, we coupled data from the Behavioral Risk Factor Surveillance System (BRFSS) and the Surveillance, Epidemiology, and End Results (SEER) program for analysis. Results showed statistically significant inequalities for CRC incidence (t = 2.678, p = 0.010) and mortality (t = 2.567, p = 0.013), as well as socioeconomic (i.e., poverty; t = 5.644, p < 0.001) and behavioral (i.e., smoking; t = 2.885, p = 0.006) factors between selected rural and urban counties.
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    • "Yet, African American (AA) women from urban and large rural areas actually received mammograms – indeed, all screening services examined – more often compared with white urban women. When these analyses were adjusted for provider availability and other factors, AA in both urban and rural settings reported higher rates of screening than whites [10]. These findings were deemed 'surprising' by the authors, and indeed, race/ethnicity is often difficult to separate from other aspects of geographical settings. "
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    ABSTRACT: Rural-urban differences in health outcomes, including breast cancer, in the US have been studied for decades, but often with inconsistent findings. Possible reasons include methodological differences, lack of prospective investigations, small number of studies overall, and the tendency to measure rurality as a simple patient-level predictor variable. Studies have tended to assume that the same racial/ethnic cancer disparities found in the general population exist in rural regions, but this conclusion may not always be warranted. Needed are better definitions of rurality; the capability to define important predictor variables such as race, ethnicity, education, and income with greater precision than at present; and data revealing the patient's own perspective regarding care decisions. Future studies should examine whether the impact of rurality status on outcomes varies with geographic location by including the appropriate interaction terms in the outcome prediction models, as well as patient-reported reasons that might explain the outcomes observed.
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    ABSTRACT: Colorectal cancer (CRC) is the third leading cause of death among women in the USA. Rural populations have lower rates of CRC screening than their urban counterparts, and rural women have lower screening rates compared with rural men. The purpose of this qualitative study was to identify (1) beliefs of primary care physicians (PCPs) about CRC screening in rural communities, (2) factors that may cause gender disparities in CRC screening in rural areas, and (3) solutions to overcome those barriers. Semi-structured interviews were conducted with 17 PCPs practicing in rural central Pennsylvania. PCPs were asked about their CRC screening practices for women, availability of CRC screening services, reminder systems for CRC screening, and barriers to screening specific to their rural communities and to gender. Thematic analysis was used to identify major themes. All 17 PCPs endorsed the importance of CRC screening, but believed that there are barriers to CRC screening specific to women and to rural location. All PCPs identified colonoscopy as their screening method of choice, and generally reported that access to colonoscopy services in their rural areas was not a significant barrier. Barriers to CRC screening for women in rural communities were related to (1) PCPs' CRC screening practices, (2) gender-specific barriers to CRC screening, (3) patient-related barriers, (4) community-related barriers, and (5) physician practice-related barriers. Physicians overwhelmingly identified patient education as necessary for improving CRC screening in their rural communities, but believed that education would have to come from a source outside the rural primary care office due to lack of resources, personnel, and time. Overall, the PCPs in this study were motivated to identify ways to improve their ability to engage more eligible patients in CRC screening. These findings suggest several interventions to potentially improve CRC screening for women in rural areas, including encouraging use of other effective CRC screening modalities (eg fecal occult blood testing) when colonoscopy is not possible, systems-based reminders that leverage electronic resources and are not visit-dependent, and public health education campaigns aimed specifically at women in rural communities.
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