Breast and Cervical Cancer Screening among Appalachian Women

Medical service shortages, rural residence, and socioeconomic and cultural factors may pose barriers to breast and cervical cancer screening among women living in the Appalachian region of the United States. This study determined the rates of breast and cervical cancer screening in Appalachia and identified factors associated with screening. Data from the Behavioral Risk Factor Surveillance System, 1996 to 1998, for the Appalachian region were analyzed to determine the percentage of women ≥40 years of age who had had a mammogram or clinical breast examination (CBE) within the past 2 years and the percentage of women ≥18 years of age who had had a Pap test within the past 3 years. Screening rates were compared with those for women living elsewhere in the United States. Screening rates were further assessed according to demographic, socioeconomic, and physical and behavioral health factors. Multiple logistic regression analyses were conducted to examine the predictors of screening. Overall, 14,520 Appalachian women ≥18 years of age reported on Pap tests; 13,223 women ≥40 years of age reported on mammogram screening, and 13,124 women reported on CBE screening. Among Appalachian women, 68.8% [95% confidence interval (CI), 67.8–69.9] had a mammogram, 75.1% (95% CI, 74.1–76.1) had a CBE in the past 2 years, and 82.4% (95% CI, 81.5–83.3) had a Pap test in the past 3 years. These rates were at most ∼3% lower than those for women living elsewhere in the United States, but these differences were statistically significant. Older women and women with less education or income were screened less commonly. Women who had visited a doctor within the past year were more likely to have been screened. Additional interventions are needed to increase breast and cervical cancer screening rates for Appalachian women to meet the goals of Healthy People 2010, targeting in particular population groups found to have lower screening rates.