Women who live in urban areas and those residing in rural areas are screened for breast cancer at similar rates, but rural women are screened for colorectal cancer at significantly lower rates than their urban counterparts, research published by Shete et al in JAMA Network Open showed.

The disparity may stem from a lack of access to colorectal screening in rural areas, the researcher noted. However, income and health insurance also may be factors: women from families that earn $50,000 or more were much more likely to get screened for colorectal cancer than women from families with incomes below $20,000. There was no such financial correlation for breast cancer screening.

The researchers said new efforts are 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 study author Rajesh Balkrishnan, PhD, of the School of Medicine at the University of Virginia. “These findings suggest that colorectal cancer screening may not be as available in rural areas as breast cancer screening.”

Study Methods and Survey Findings

To understand how often women in rural and urban areas get screened for breast and colorectal cancers, the researchers looked at responses from 2,897 women aged 50 to 75 years to surveys at 11 sites around the country.

About 81% of both urban and rural women were up to date on their breast cancer screenings. Seventy-eight percent of rural women were following the colorectal cancer screening guidelines; in comparison, 82% of urban women reported getting screened for colorectal cancer.

The researchers said 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, may be 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 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.

Additionally, the team found that mammography screening was significantly higher in non-Hispanic Black women than in non-Hispanic White women. This difference could not be explained by location or other factors. 

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 Dr. Balkrishnan. “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.”

Disclosure: The study was funded by the National Cancer and the American Cancer Society. For full disclosures of the study authors, visit jamanetwork.com.