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Differences in Breast and Colorectal Cancer Screening Adherence Among Women Residing in Urban and Rural Communities in the United States

IMPORTANCE: Screening for breast and colorectal cancer has resulted in reductions in mortality; however, questions remain regarding how these interventions are being diffused to all segments of the population. If an intervention is less amenable to diffusion, it could be associated with disparities...

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Autores principales: Shete, Sanjay, Deng, Yangyang, Shannon, Jackilen, Faseru, Babalola, Middleton, Deirdre, Iachan, Ronaldo, Bernardo, Brittany, Balkrishnan, Rajesh, Kim, Sunny Jung, Huang, Bin, Millar, Morgan M., Fuemmler, Bernard, Jensen, Jakob D., Mendoza, Jason A., Hu, Jinxiang, Lazovich, DeAnn, Robertson, Linda, Demark-Wahnefried, Wendy, Paskett, Electra D.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8491105/
https://www.ncbi.nlm.nih.gov/pubmed/34605915
http://dx.doi.org/10.1001/jamanetworkopen.2021.28000
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author Shete, Sanjay
Deng, Yangyang
Shannon, Jackilen
Faseru, Babalola
Middleton, Deirdre
Iachan, Ronaldo
Bernardo, Brittany
Balkrishnan, Rajesh
Kim, Sunny Jung
Huang, Bin
Millar, Morgan M.
Fuemmler, Bernard
Jensen, Jakob D.
Mendoza, Jason A.
Hu, Jinxiang
Lazovich, DeAnn
Robertson, Linda
Demark-Wahnefried, Wendy
Paskett, Electra D.
author_facet Shete, Sanjay
Deng, Yangyang
Shannon, Jackilen
Faseru, Babalola
Middleton, Deirdre
Iachan, Ronaldo
Bernardo, Brittany
Balkrishnan, Rajesh
Kim, Sunny Jung
Huang, Bin
Millar, Morgan M.
Fuemmler, Bernard
Jensen, Jakob D.
Mendoza, Jason A.
Hu, Jinxiang
Lazovich, DeAnn
Robertson, Linda
Demark-Wahnefried, Wendy
Paskett, Electra D.
author_sort Shete, Sanjay
collection PubMed
description IMPORTANCE: Screening for breast and colorectal cancer has resulted in reductions in mortality; however, questions remain regarding how these interventions are being diffused to all segments of the population. If an intervention is less amenable to diffusion, it could be associated with disparities in mortality rates, especially in rural vs urban areas. OBJECTIVES: To compare the prevalence of breast and colorectal cancer screening adherence and to identify factors associated with screening adherence among women residing in rural vs urban areas in the United States. DESIGN, SETTING, AND PARTICIPANTS: This population-based cross-sectional study of women aged 50 to 75 years in 11 states was conducted from 2017 to 2020. MAIN OUTCOMES AND MEASURES: Adherence to cancer screening based on the US Preventative Services Task Force guidelines. For breast cancer screening, women who had mammograms in the past 2 years were considered adherent. For colorectal cancer screening, women who had (1) a stool test in the past year, (2) a colonoscopy in the past 10 years, or (3) a sigmoidoscopy in the past 5 years were considered adherent. Rural status was coded using Rural Urban Continuum Codes, and other variables were assessed to identify factors associated with screening. RESULTS: The overall sample of 2897 women included 1090 (38.4%) rural residents; 2393 (83.5%) non-Hispanic White women; 263 (9.2%) non-Hispanic Black women; 68 (2.4%) Hispanic women; 1629 women (56.2%) aged 50 to 64 years; and 712 women (24.8%) with a high school education or less. Women residing in urban areas were significantly more likely to be adherent to colorectal cancer screening compared with women residing in rural areas (1429 [82%] vs 848 [78%]; P = .01), whereas the groups were equally likely to be adherent to breast cancer screening (1347 [81%] vs 830 [81%]; P = .78). Multivariable mixed-effects logistic regression analyses confirmed that rural residence was associated with lower odds of being adherent to colorectal cancer screening (odds ratio [OR], 0.81; 95% CI, 0.66-0.99, P = .047). Non-Hispanic Black race was associated with adherence to breast cancer screening guidelines (OR, 2.85; 95% CI, 1.78-4.56; P < .001) but not colorectal cancer screening guidelines. CONCLUSIONS AND RELEVANCE: In this cross-sectional study, women residing in rural areas were less likely to be adherent to colorectal cancer screening guidelines but were similarly adherent to breast cancer screening. This suggests that colorectal cancer screening, a more recent intervention, may not be as available in rural areas as breast cancer screening, ie, colorectal screening has lower amenability.
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spelling pubmed-84911052021-10-20 Differences in Breast and Colorectal Cancer Screening Adherence Among Women Residing in Urban and Rural Communities in the United States Shete, Sanjay Deng, Yangyang Shannon, Jackilen Faseru, Babalola Middleton, Deirdre Iachan, Ronaldo Bernardo, Brittany Balkrishnan, Rajesh Kim, Sunny Jung Huang, Bin Millar, Morgan M. Fuemmler, Bernard Jensen, Jakob D. Mendoza, Jason A. Hu, Jinxiang Lazovich, DeAnn Robertson, Linda Demark-Wahnefried, Wendy Paskett, Electra D. JAMA Netw Open Original Investigation IMPORTANCE: Screening for breast and colorectal cancer has resulted in reductions in mortality; however, questions remain regarding how these interventions are being diffused to all segments of the population. If an intervention is less amenable to diffusion, it could be associated with disparities in mortality rates, especially in rural vs urban areas. OBJECTIVES: To compare the prevalence of breast and colorectal cancer screening adherence and to identify factors associated with screening adherence among women residing in rural vs urban areas in the United States. DESIGN, SETTING, AND PARTICIPANTS: This population-based cross-sectional study of women aged 50 to 75 years in 11 states was conducted from 2017 to 2020. MAIN OUTCOMES AND MEASURES: Adherence to cancer screening based on the US Preventative Services Task Force guidelines. For breast cancer screening, women who had mammograms in the past 2 years were considered adherent. For colorectal cancer screening, women who had (1) a stool test in the past year, (2) a colonoscopy in the past 10 years, or (3) a sigmoidoscopy in the past 5 years were considered adherent. Rural status was coded using Rural Urban Continuum Codes, and other variables were assessed to identify factors associated with screening. RESULTS: The overall sample of 2897 women included 1090 (38.4%) rural residents; 2393 (83.5%) non-Hispanic White women; 263 (9.2%) non-Hispanic Black women; 68 (2.4%) Hispanic women; 1629 women (56.2%) aged 50 to 64 years; and 712 women (24.8%) with a high school education or less. Women residing in urban areas were significantly more likely to be adherent to colorectal cancer screening compared with women residing in rural areas (1429 [82%] vs 848 [78%]; P = .01), whereas the groups were equally likely to be adherent to breast cancer screening (1347 [81%] vs 830 [81%]; P = .78). Multivariable mixed-effects logistic regression analyses confirmed that rural residence was associated with lower odds of being adherent to colorectal cancer screening (odds ratio [OR], 0.81; 95% CI, 0.66-0.99, P = .047). Non-Hispanic Black race was associated with adherence to breast cancer screening guidelines (OR, 2.85; 95% CI, 1.78-4.56; P < .001) but not colorectal cancer screening guidelines. CONCLUSIONS AND RELEVANCE: In this cross-sectional study, women residing in rural areas were less likely to be adherent to colorectal cancer screening guidelines but were similarly adherent to breast cancer screening. This suggests that colorectal cancer screening, a more recent intervention, may not be as available in rural areas as breast cancer screening, ie, colorectal screening has lower amenability. American Medical Association 2021-10-04 /pmc/articles/PMC8491105/ /pubmed/34605915 http://dx.doi.org/10.1001/jamanetworkopen.2021.28000 Text en Copyright 2021 Shete S et al. JAMA Network Open. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Shete, Sanjay
Deng, Yangyang
Shannon, Jackilen
Faseru, Babalola
Middleton, Deirdre
Iachan, Ronaldo
Bernardo, Brittany
Balkrishnan, Rajesh
Kim, Sunny Jung
Huang, Bin
Millar, Morgan M.
Fuemmler, Bernard
Jensen, Jakob D.
Mendoza, Jason A.
Hu, Jinxiang
Lazovich, DeAnn
Robertson, Linda
Demark-Wahnefried, Wendy
Paskett, Electra D.
Differences in Breast and Colorectal Cancer Screening Adherence Among Women Residing in Urban and Rural Communities in the United States
title Differences in Breast and Colorectal Cancer Screening Adherence Among Women Residing in Urban and Rural Communities in the United States
title_full Differences in Breast and Colorectal Cancer Screening Adherence Among Women Residing in Urban and Rural Communities in the United States
title_fullStr Differences in Breast and Colorectal Cancer Screening Adherence Among Women Residing in Urban and Rural Communities in the United States
title_full_unstemmed Differences in Breast and Colorectal Cancer Screening Adherence Among Women Residing in Urban and Rural Communities in the United States
title_short Differences in Breast and Colorectal Cancer Screening Adherence Among Women Residing in Urban and Rural Communities in the United States
title_sort differences in breast and colorectal cancer screening adherence among women residing in urban and rural communities in the united states
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8491105/
https://www.ncbi.nlm.nih.gov/pubmed/34605915
http://dx.doi.org/10.1001/jamanetworkopen.2021.28000
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