Trends in Cervical & Breast Cancer Screening Practices among Women in Rural & Urban Areas of the United States AcademyHealth 2008 Gender and Health Interest Group Meeting June 7, 2008 Mark P. Doescher, MD, MSPH J. Elizabeth Jackson, MA Department of Family Medicine University of Washington School of Medicine
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Trends in Cervical & Breast Cancer Screening Practices among Women in Rural & Urban Areas of the United States AcademyHealth 2008 Gender and Health Interest.
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Trends in Cervical & Breast Cancer Screening Practices among Women in
Rural & Urban Areas of the United States
AcademyHealth 2008Gender and Health Interest Group Meeting
June 7, 2008
Mark P. Doescher, MD, MSPHJ. Elizabeth Jackson, MA
Department of Family MedicineUniversity of Washington School of Medicine
Background
Disparities in cancer screening for rural women have been reported by others
A more refined definition of rural residence may allow identification of areas where need for services is especially great
Guidelines
Periodic screening for breast cancer and cervical cancer can reduce risk of premature death
USPSTF recommendations: Mammogram for women aged 40+ every two
years Papanicoloau (Pap) smear for women aged
18+ every three years
Disparities
Rates of Pap screening fall short of Healthy People 2010 goal of 90%
Less frequent use of preventive services among rural women may be due to: Greater distance to medical facilities Less accessibility of services Inadequate health insurance coverage
Rural disparity more pronounced among racial/ethnic minorities
Study Aims
Aim 1
To examine the prevalence of and trends in mammography and Pap smear screening among adult women living in rural and urban locations between 1994 and 2004.
Aim 2
To explore the uptake of these tests among groups of rural women who might be relatively unlikely to benefit from any temporal improvements in screening.
Data and Methods
Data
Behavioral Risk Factor Surveillance System (BRFSS)
Women aged 18+ for Pap screening and 40+ for mammography
Annual samples from 1994-2000, 2002 and 2004 (1994 n=105,853, 2004 n=303,822)
United States (excluding District of Columbia, New Jersey, Rhode Island and Alaska, and territories)
Data –
Dependent Measures
Women were asked: If they had ever had a mammogram and the
date of their most recent mammogram If they had ever had a Pap smear and the date
of their most recent test; also asked whether they had had a hysterectomy
Classified as up-to-date if: Mammogram within prior two years Pap smear within prior three years
Data –
Key Independent Measures
Rural/urban residence classified by county by 2003 Urban Influence Code (UIC) Metropolitan Non-metro: 1) adjacent non-metro; 2) remote