Breast and cervical carcinoma screening practices among women in rural and nonrural areas of the United States, 1998–1999

Abstract

BACKGROUND Prior studies have suggested that women living in rural areas may be less likely than women living in urban areas to have had a recent mammogram and Papanicolau (Pap) test and that rural women may face substantial barriers to receiving preventive health care services. METHODS The authors examined both breast and cervical carcinoma screening practices of women living in rural and nonrural areas of the United States from 1998 through 1999 using data from the Behavioral Risk Factor Surveillance System. The authors limited their analyses of screening mammography and clinical breast examination to women aged 40 years or older (n = 108,326). In addition, they limited their analyses of Pap testing to women aged 18 years or older who did not have a history of hysterectomy (n = 131,813). They divided the geographic areas of residence into rural areas and small towns, suburban areas and smaller metropolitan areas, and larger metropolitan areas. RESULTS Approximately 66.7% (95% confidence interval [CI] = 65.8% to 67.6%) of women aged 40 years or older who resided in rural areas had received a mammogram in the past 2 years, compared with 75.4% of women living in larger metropolitan areas (95% CI = 74.9% to 75.9%). About 73.0% (95% CI = 72.2% to 73.9%) of women aged 40 years or older who resided in rural areas had received a clinical breast examination in the past 2 years, compared with 78.2% of women living in larger metropolitan areas (95% CI = 77.8% to 78.7%). About 81.3% (95% CI = 80.6% to 82.0%) of 131,813 rural women aged 18 years or older who had not undergone a hysterectomy had received a Pap test in the past 3 years, compared with 84.5% of women living in larger metropolitan areas (95% CI = 84.1% to 84.9%). The differences in screening across rural and nonrural areas persisted in multivariate analysis (P < 0.001). CONCLUSIONS These results underscore the need for continued efforts to provide breast and cervical carcinoma screening to women living in rural areas of the United States. Cancer 2002; 94:2801–12. © 2002 American Cancer Society. DOI 10.1002/cncr.10577

Cancer Screening Practices Among Physicians in the National Breast and Cervical Cancer Early Detection Program

“…17,18 These findings are consistent with those of Saraiya et al, 4 who found that program providers were well poised to serve those women at the highest risk of cervical cancer because they were more likely than nonprogram providers to serve racially diverse, uninsured, publicly insured, and rural patients.…”

Determinants of Cervical Cancer Screening among Women with Intellectual Disabilities: Evidence from Medical Records

“…Our findings that women living at home with family caregivers were less likely to receive Pap tests corroborates recent evidence that rates of preventive screenings are generally worse for adults with intellectual disabilities who live at home rather than in residential settings. 10,25 However, an unexpected 41,42 suggesting that further research is warranted. These findings suggest that (1) women with intellectual disabilities are not receiving cervical cancer screening at recommended rates or at rates similar to women without intellectual disabilities, (2) interventions to improve Pap test rates for women in the general population have failed to reach women with intellectual disabilities, and (3) there is a need for specialized screening guidelines for women with intellectual disabilities.…”

Variability of cervical cancer rates across 5 Appalachian states, 1998-2003

“…A lower prevalence of Pap testing also tends to occur among rural populations. 19,[29][30][31][32] However, the interplay between socioeconomic factors, smoking, and Pap testing is complex because women who smoke, as a whole, may be more likely to engage in risky behavior, including a higher risk of exposure to HPV infection through a larger number of sexual partners. [33][34][35][36] The census data presented in Table 1 shows that KY, WV, and AL have similar rates of education and poverty, yet the rates of ICC are considerably lower in AL.…”