Comparing Rural and Urban Cervical and Breast Cancer Screening Rates in a Privately Insured Population

ABSTRACT Low preventive screening varies by region and contributes to poor outcomes for breast and cervical cancer. Previous comparative urban and rural research on preventive screening has focused on government programs. This study quantified and compared rural and urban preventive cancer screening rates for women who were privately insured. National Quality Forum measures were used to calculate rates for women within rural and urban parts of the same Hospital Referral Region (HRR) using claims data. Mammography screening rates for women age 24 to 69 years were 77.1% in 2011 and 76.1% in 2008. Compared to urban women, mammography screening rates for women visiting rural physicians were lower in 42%, higher in 2% and identical in 56% of HRRs. Cervical cancer screening rates for women age 21 to 64 years were 82.9% in 2011 and 83.5% in 2008. Cervical cancer screening rates among women who saw rural physicians were lower in 55%, higher in 4%, and identical in 42% of HRRs. HRRs where rural areas underperformed urban areas increased between 2008 and 2011 for both screenings. Moderate but notable differences in women’s preventive screening rates between rural and urban physicians highlight the need for practical solutions that increase use of screening services and reduce barriers to services in rural areas.

[1]  L. S. Minckler,et al.  Racial Differences , 1961, Science.

[2]  N. Lee,et al.  The National Breast and Cervical Cancer Early Detection Program: a comprehensive public health response to two major health issues for women. , 1996, Journal of public health management and practice : JPHMP.

[3]  Daniel S. Miller,et al.  Breast and cervical cancer screening among Appalachian women. , 2002, Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology.

[4]  R. Phillips,et al.  Receipt of preventive care among adults: insurance status and usual source of care. , 2003, American journal of public health.

[5]  Stephanie L. Dickinson,et al.  Racial differences in knowledge, attitudes, and cancer screening practices among a triracial rural population , 2004, Cancer.

[6]  R. Shell,et al.  Barriers to cancer screening by rural Appalachian primary care providers. , 2004, The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association.

[7]  C. Davis,et al.  Breast Cancer Screening Among African American Women: Adherence to Current Recommendations , 2005, Journal of health care for the poor and underserved.

[8]  C. Skinner,et al.  Pain predicts non-adherence to pap smear screening among middle-aged African American women. , 2005, Preventive medicine.

[9]  T. McBride,et al.  Choosing Rural Definitions: Implications for Health Policy , 2007 .

[10]  M. Peek,et al.  Fear, Fatalism and Breast Cancer Screening in Low-Income African-American Women: The Role of Clinicians and the Health Care System , 2008, Journal of General Internal Medicine.

[11]  J. Halverson,et al.  Leuconostoc spp sepsis in an extremely low birth weight infant: a case report and review of the literature. , 2009 .

[12]  Breast cancer screening, incidence, and mortality in West Virginia. , 2009, The West Virginia medical journal.

[13]  Christopher S. Carpenter,et al.  Insurance Mandates and Mammography , 2009 .

[14]  M. Doescher,et al.  Trends in cervical and breast cancer screening practices among women in rural and urban areas of the United States. , 2009, Journal of public health management and practice : JPHMP.

[15]  E John Orav,et al.  Quality of care and patient outcomes in critical access rural hospitals. , 2011, JAMA.

[16]  M. Siahpush,et al.  Socioeconomic, Rural-Urban, and Racial Inequalities in US Cancer Mortality: Part I—All Cancers and Lung Cancer and Part II—Colorectal, Prostate, Breast, and Cervical Cancers , 2012, Journal of cancer epidemiology.

[17]  M. Ory,et al.  Utilization of screening mammography among middle-aged and older women. , 2011, Journal of women's health.

[18]  C. Klabunde,et al.  Trends in Colorectal Cancer Test Use among Vulnerable Populations in the United States , 2011, Cancer Epidemiology, Biomarkers & Prevention.

[19]  John S. Luque,et al.  Do Community Health Worker Interventions Improve Rates of Screening Mammography in the United States? A Systematic Review , 2011, Cancer Epidemiology, Biomarkers & Prevention.

[20]  Gopal K Singh.  Rural–Urban Trends and Patterns in Cervical Cancer Mortality, Incidence, Stage, and Survival in the United States, 1950–2008 , 2012, Journal of Community Health.

[21]  Suresh Madhavan,et al.  Factors Influencing Adherence to Mammography Screening Guidelines in Appalachian Women Participating in a Mobile Mammography Program , 2012, Journal of Community Health.

[22]  D. Lieberman,et al.  Influence of health insurance coverage on breast, cervical, and colorectal cancer screening in rural primary care settings , 2012, Cancer.

[23]  E. K. Adams,et al.  Mammography rates after the 2009 US Preventive Services Task Force breast cancer screening recommendation. , 2012, Preventive medicine.

[24]  J. Hay,et al.  Awareness of the 2009 US Preventive Services Task Force recommended changes in mammography screening guidelines, accuracy of awareness, sources of knowledge about recommendations, and attitudes about updated screening guidelines in women ages 40–49 and 50+ , 2012, BMC Public Health.

[25]  W. Rayburn,et al.  Distribution of American Congress of Obstetricians and Gynecologists Fellows and Junior Fellows in Practice in the United States , 2012, Obstetrics and gynecology.

[26]  R. Sandler,et al.  Impact of the 2008-2009 economic recession on screening colonoscopy utilization among the insured. , 2012, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[27]  Britteny M. Howell,et al.  Community Strategies to Address Cancer Disparities in Appalachian Kentucky , 2012, Family & community health.

[28]  Randy W. Elder,et al.  Effectiveness of interventions to increase screening for breast, cervical, and colorectal cancers: nine updated systematic reviews for the guide to community preventive services. , 2012, American journal of preventive medicine.

[29]  D. Ekwueme,et al.  Characteristics of US Counties with No Mammography Capacity , 2012, Journal of Community Health.

[30]  Sidney D. Watson,et al.  Pursuing High Performance in Rural Health Care , 2012 .

[31]  M. Marmot.  Sorting through the arguments on breast screening. , 2013, JAMA.

[32]  E. Ellerbeck,et al.  Adherence to Cancer Screening Guidelines and Predictors of Improvement Among Participants in the Kansas State Employee Wellness Program , 2013, Preventing chronic disease.

[33]  Mph Wendy L. Bennett MD,et al.  Mammography Use Among Women Ages 40–49 After the 2009 U.S. Preventive Services Task Force Recommendation , 2013, Journal of General Internal Medicine.

[34]  Do Appalachian Women Attending a Mobile Mammography Program Differ from Those Visiting a Stationary Mammography Facility? , 2013, Journal of Community Health.

[35]  Allen Kachalia,et al.  Breast cancer screening: conflicting guidelines and medicolegal risk. , 2013, JAMA.

[36]  N. Keating,et al.  Trends in mammography screening rates after publication of the 2009 US Preventive Services Task Force recommendations , 2013, Cancer.

[37]  Nancy L Keating,et al.  A systematic assessment of benefits and risks to guide breast cancer screening decisions. , 2014, JAMA.

[38]  J. Probst,et al.  Rural Health Research Center , 2015 .

[39]  Christopher S. Carpenter,et al.  Health Insurance Mandates, Mammography, and Breast Cancer Diagnoses , 2011, American economic journal. Economic policy.

[40]  T. Kessler,et al.  Cervical Cancer: Prevention and Early Detection. , 2017, Seminars in oncology nursing.