Differences in Breast and Colorectal Cancer Screening Adherence among Women Residing in Urban and Rural Communities in the United States

Sanjay Shete, Yangyang Deng, Jackilen Shannon, Babalola Faseru, Deirdre Middleton, Ronaldo Iachan, Brittany Bernardo, Rajesh Balkrishnan, Sunny Jung Kim, Bin Huang, Morgan M. Millar, Bernard Fuemmler, Jakob D. Jensen, Jason A. Mendoza, Jinxiang Hu, Deann Lazovich, Linda Robertson, Wendy Demark-Wahnefried, Electra D. Paskett

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31 Scopus citations


Importance: Screening for breast and colorectal cancer has resulted in reductions in mortality; however, questions remain regarding how these interventions are being diffused to all segments of the population. If an intervention is less amenable to diffusion, it could be associated with disparities in mortality rates, especially in rural vs urban areas. Objectives: To compare the prevalence of breast and colorectal cancer screening adherence and to identify factors associated with screening adherence among women residing in rural vs urban areas in the United States. Design, Setting, and Participants: This population-based cross-sectional study of women aged 50 to 75 years in 11 states was conducted from 2017 to 2020. Main Outcomes and Measures: Adherence to cancer screening based on the US Preventative Services Task Force guidelines. For breast cancer screening, women who had mammograms in the past 2 years were considered adherent. For colorectal cancer screening, women who had (1) a stool test in the past year, (2) a colonoscopy in the past 10 years, or (3) a sigmoidoscopy in the past 5 years were considered adherent. Rural status was coded using Rural Urban Continuum Codes, and other variables were assessed to identify factors associated with screening. Results: The overall sample of 2897 women included 1090 (38.4%) rural residents; 2393 (83.5%) non-Hispanic White women; 263 (9.2%) non-Hispanic Black women; 68 (2.4%) Hispanic women; 1629 women (56.2%) aged 50 to 64 years; and 712 women (24.8%) with a high school education or less. Women residing in urban areas were significantly more likely to be adherent to colorectal cancer screening compared with women residing in rural areas (1429 [82%] vs 848 [78%]; P =.01), whereas the groups were equally likely to be adherent to breast cancer screening (1347 [81%] vs 830 [81%]; P =.78). Multivariable mixed-effects logistic regression analyses confirmed that rural residence was associated with lower odds of being adherent to colorectal cancer screening (odds ratio [OR], 0.81; 95% CI, 0.66-0.99, P =.047). Non-Hispanic Black race was associated with adherence to breast cancer screening guidelines (OR, 2.85; 95% CI, 1.78-4.56; P <.001) but not colorectal cancer screening guidelines. Conclusions and Relevance: In this cross-sectional study, women residing in rural areas were less likely to be adherent to colorectal cancer screening guidelines but were similarly adherent to breast cancer screening. This suggests that colorectal cancer screening, a more recent intervention, may not be as available in rural areas as breast cancer screening, ie, colorectal screening has lower amenability..

Original languageEnglish
Article number28000
JournalJAMA network open
Issue number10
StatePublished - Oct 4 2021

Bibliographical note

Funding Information:
Conflict of Interest Disclosures: Dr Paskett reported receiving grants from the Merck Foundation, Pfizer, and the Breast Cancer Research Foundation outside the submitted work. No other disclosures were reported.

Funding Information:
Funding/Support: Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under award numbers P30CA016058 (Ohio State University); P30CA044579-27S5 (University of Virginia); P30CA013148-46S5 (O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham as well as grant CRP-19-175-06-COUN from the American Cancer Society to Dr Denmark-Wahnefried), P30 CA168524-07S2 and CTSA Award UL1TR002366 (University of Kansas Cancer Center and University of Kansas Medical Center); P30 CA06953-20S1 (Population Health Supplement to the OHSU Knight Cancer Institute); P30CA047904-28S3 (UPMC Hillman Cancer Center); 3P30 CA177558-04S5 (Population Health Supplement to the University of Kentucky Markey Cancer Center); P30CA015704-43S4 (Fred Hutch/University of Washington Cancer Consortium); P30 CA016059-30 (Virginia Commonwealth University); 3P30CA069533 (Oregon Health & Science University); P30 CA042014-29S7 (University of Utah); P30 CA082709-17S6 (Indiana University); 5P30CA077598 (University of Minnesota); and P30CA016672 (The University of Texas MD Anderson Cancer Center).

Publisher Copyright:
© 2021 Georg Thieme Verlag. All rights reserved.

ASJC Scopus subject areas

  • Medicine (all)


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