Rural women less likely to get colorectal cancer screening

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Both rural and urban women follow breast cancer screening guidelines at similar rates, but rural women are less likely to get colorectal cancer screening, according to a study published October 4 in JAMA Network Open.

The study results further illuminate an area of healthcare disparity that must be addressed, wrote a team led by Sanjay Shete, PhD, of MD Anderson Cancer Center in Houston.

"While rural regions experience similar incidence of most cancers compared to urban areas, some cancers that can be prevented with regular screenings, such as cervical, colorectal, and lung cancer, have a higher prevalence in rural areas," the group wrote.

Cancer prevalence and mortality rates have been falling, but not all patient populations see similar declines, the authors noted. Why? Disparities in rural areas may be due in part to "poor health behaviors" like tobacco use and a sedentary lifestyle as well as to a lack of access to screening and treatment.

Shete and colleagues sought to compare rates of breast and colorectal cancer screening by geographic location via a study that included 2,897 women between the ages of 50 and 75 in 11 states who underwent breast and colorectal cancer screening between 2017 and 2020. The group assessed screening compliance using U.S. Preventive Services Task Force (USPSTF) guidelines. The investigators categorized the location of participants as urban or rural using the U.S. Department of Agriculture's Economic Research Service Rural Urban Continuum Codes.

Of the study cohort, 38.4% (1,090) were residents of rural areas. The team also found the following demographic information:

  • 83.5% were non-Hispanic white women
  • 9.2% were non-Hispanic Black women
  • 2.4% were Hispanic women
  • 56.2% were between the ages of 50 to 64 years
  • 24.8% were women with a high school education or less

The investigators found that both rural and urban women were equally likely to be compliant with breast cancer screening (both groups, 81%). But rural women were less likely to comply with colorectal cancer screening compared with their urban counterparts (78% vs. 82%), a result that was statistically significant (p = 0.01).

Compliance with cancer screening by geographic location
Metric Urban women Rural women p-value
Breast cancer screening
Likelihood of compliance 81% 81% 0.78
Colorectal cancer screening
Likelihood of compliance 82% 78% 0.01

The team also found that rural women had lower odds of complying with colorectal cancer screening than urban women (odds ratio, 0.81). Black women tended to comply with breast cancer screening guidelines but not colorectal cancer screening recommendations.

The disparities may be due to "a slower diffusion of colorectal cancer screening and present significant preventable health challenges," the group noted.

"[Our findings are important], as previous studies looking at diffusion of interventions as a cause of disparities have only identified this trend by race, ethnicity, and age, not by rural status," the authors concluded. "[This] difference ... suggests that public health interventions should focus efforts to increase colorectal cancer screening in rural areas."

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