Researchers find colorectal cancer screening lags among rural women

The disparity may stem from a lack of access to colorectal screening in rural areas, the researchers believe. But income and insurance also may be factors: Women from families that earn USD 50,000 or more were much more likely to get screened for colorectal cancer than women from families with incomes below USD 20,000. There was no such financial correlation for breast cancer screening. The researchers said that new efforts were needed to increase colorectal cancer screenings for rural residents. 

"Using survey data from 11 states in the United States, we were able to demonstrate that rural-dwelling women had lower rates of adherence to colorectal cancer screening compared with women living in urban areas. 

However, both groups of women had similar rates of adherence to breast cancer screening," said researcher Rajesh Balkrishnan, PhD, University of Virginia School of Medicine and UVA Cancer Center. "These findings suggest that colorectal cancer screening may not be as available in rural areas as breast cancer screening," he added. 

To understand how often women in rural and urban areas get screened for breast and colorectal cancer, Balkrishnan and colleagues looked at responses from 2,897 women, ages 50 to 75, surveyed at 11 sites around the country, including UVA, Virginia Commonwealth University, the University of Pittsburgh and the University of Alabama at Birmingham.

About 81 per cent of both urban and rural women were up to date on their breast cancer screenings, but only 78 per cent of rural women were following the colorectal cancer screening guidelines. In comparison, 82 per cent of urban women were getting screened for colorectal cancer. The researchers said that the disparity in colorectal cancer screenings may stem from the slow arrival of new screening methods to rural areas. They hypothesized that fewer rural residents may be getting screened for colorectal cancer because they don't have easy access to testing. 

Travel times, for example, maybe a barrier, and it may be difficult for people to get time off work, especially for those with lower-paying jobs. The researchers noted that women who had health insurance were two to three times more likely to comply with breast cancer and colorectal cancer screening guidelines than women without insurance. "Increase in health care coverage as a result of the Patient Protection and Affordable Care Act, which included the elimination of copay for preventive health services including breast and colorectal cancer screening, has been well documented and found to be associated with an increase in screening rates for breast and colorectal cancer," the researchers wrote in a new scientific paper outlining their findings. 

In response to their findings, the researchers are urging public health interventions to increase colorectal cancer screening among rural women. For example, rural residents may benefit from campaigns to increase awareness of home colorectal cancer testing that can be done by mail. "While the rural health disparities observed in this study present substantial public health challenges, it is possible to improve cancer outcomes through appropriate public health interventions," said Balkrishnan, UVA's Department of Public Health Sciences. "Interventions that improve patient navigation and education related to the importance of cancer screenings have a potential to improve access and use of cancer screening in rural areas," he concluded.