Differences Related to Cancer Screening by Minority and Rural/Urban Status in the Deep South: Population-based Survey Results

Abstract

Objective: Cancer mortality in the U.S. Deep South exceeds national levels. A cross-sectional survey was undertaken across Alabama to discern cancer beliefs and screening practices, and compare data from racial/ethnic minority versus majority and rural versus urban respondents. Methods: Using population-based methods, we approached 5,633 Alabamians (ages 50-80) to complete a 58-item survey (administered in-person, via telephone, or the web). Descriptive statistics were used to summarize findings; two-tailed, chi-square and t-tests (α<0.05) were used to compare minority-majority and rural-urban subgroups. Results: The response rate was 15.2%; respondents identified as minority (n=356) or majority (n=486), and rural (n=671) or urban (n=183). Mean (SD) age was 63.7 (10.2) and >90% indicated stable housing, and healthcare coverage and access. Rural and minority versus urban and majority respondents were significantly more likely to have lower education, employment, and income, respectively. Most respondents equated cancer as a “death sentence” and were unable to identify the age at which cancer screening should begin. Few rural-urban subgroup differences were noted, though significant differences were observed between minority versus majority subgroups for mammography (36.7% versus 49.6%, p<.001) and colorectal cancer screening (34.5% vs. 47.9%, p <0.001). Furthermore, while minorities were significantly more likely to report ever having a colonoscopy (82.1% versus 76.1%, p =0.041) and to have received fecal occult blood testing within the past year (17.2% versus 12.2%, p =0.046), routine adherence to screening was <20% across all subgroups. Discussion: Cancer early detection education is needed across Alabama to improve cancer screening, and particularly needed among racial/ethnic minorities to raise cancer awareness.

Rural-urban difference in colorectal cancer mortality

“…The results of the present review were therefore controversial; namely, a rural-urban difference in colorectal cancer mortality was not obviously proven. Of note, the present findings appear to be in line with the results reported by Daniel et al 1 . While Daniel et al hypothesized that rural residents often acknowledge a family history of cancer and cope with it well, more studies are warranted to clarify the detailed reasons for these findings.…”

“…We read with great interest the recent study by Daniel et al, which showed a different response to knowledge and practice in relation to colorectal cancer screening between minority and majority populations in the deep south of the U.S. 1 . As Daniel et al stated 1 , rurality is a possible contributor to increased mortality in patients with colorectal cancer because several factors related to lifestyle, and socioeconomics and healthcare systems are associated with the diagnosis and clinical course of this disease. Thus, the study assumed the difference in responses to colorectal cancer screening between rural and urban residents - interestingly, however, few differences were found 1 .…”

“…As Daniel et al stated 1 , rurality is a possible contributor to increased mortality in patients with colorectal cancer because several factors related to lifestyle, and socioeconomics and healthcare systems are associated with the diagnosis and clinical course of this disease. Thus, the study assumed the difference in responses to colorectal cancer screening between rural and urban residents - interestingly, however, few differences were found 1 . This might be an unexpected finding, as it is generally considered that rural-urban health inequity in cancer treatment is an issue that remains to be resolved.…”

Cancer-related Beliefs and Preventive Health Practices among Residents of Rural versus Urban Counties in Alabama

“…An exception occurred for residents of rural Clay County where an intensive face-to-face cancer prevention and control effort was underway; there, paper surveys were administered randomly to individuals in the community (e.g., dollar store, senior center, health department); paper-based surveys also were administered in the more urban Mobile County area to achieve balance in survey mode between rural: urban counties and adequate representation across counties. Given that the survey also collected data on cancer screening (data reported in another article), [9] solicitations were directed toward county residents who were 50-80 years of age. Individuals not opting-out or not completing the survey within two weeks were telephoned up to six times.…”

Patient and Radiologist Demographics Influence Perceptions of Screening Mammography Reports

“…Diversifying the field of radiology is a major goal of many radiology departments and professional organizations, but comparable studies on how radiologist demographics may influence patients' perceptions of their radiology care are lacking [9]. This is especially important for breast imaging, which is challenged by screening mammography adherence and racial/ethnic disparities in breast cancer outcomes [10][11][12]. As patients may self-refer for screening mammography, and examinations are performed in the outpatient setting, there may be a gap in time between screening mammography and the next primary care provider contact.…”