Residents of the rural Southern United States were less likely to get important screening tests for colorectal or breast cancer than people who lived in small towns or suburbia.
The regional disparities in cancer screening were more pronounced than racial disparities between whites and blacks, according to the study appearing in the Nov. 15 issue of the journal Cancer.
"The take-home message underscores the need for continued efforts to make sure adults in the rural South receive educational messages, outreach and provider recommendations about the importance of routine cancer screening," says Steven Coughlin, lead author of the study and an epidemiologist at the U.S. Centers for Disease Control and Prevention (CDC).
Still, racial disparities in cancer screening do persist, Coughlin adds.
The rural South includes certain counties in the 11 historically impoverished states that range contiguously from Virginia to Florida to Texas.
Researchers used data from the CDC's Behavioral Risk Factor Surveillance System, a telephone survey that collected health information on nearly 6,000 U.S. residents nationwide from 1997 to 2000.
Researchers found 69 percent of white women and 66 percent of black women in rural southern U.S. counties had a mammography for breast cancer screening in the past two years.
About 75 percent of whites and blacks who lived in non-rural counties of the South had mammographies.
Even more striking was the regional differences in colorectal cancer screening. Federal government guidelines say men and women over age 50 should have a fecal occult blood test (to test for blood in the stool) yearly and a sigmoidoscopy or colonoscopy every five years. People at high risk of the disease due to family history or a history of polyps should have those tests more often.
In the rural South, 38 percent of white women and 29 percent of black women said they had a flexible sigmoidoscopy or colonoscopy at least once. In non-rural counties of the South, 44 percent of whites and 37 percent of blacks had the test.
About 45 percent of white women and 43 percent of black women had the screenings throughout the United States.
The same pattern held true for fecal occult blood test. Women in the rural South were the least likely of anyone to have that test done.
Men in the rural South, particularly black men, were also the least likely to get tested for colorectal cancer. When asked if they'd ever had a fecal occult blood test, only about 28 percent of white men and 22 percent of black men said "yes."
In the remainder of the United States, about 37 percent of white men and 36 percent of black men had at least fecal occult blood test.
Steve Wilhide, executive director of the National Rural Health Association, says the findings don't surprise him.
There are many barriers to health care in the rural South, he says, from no health insurance or inadequate health insurance to a mistrust of modern medicine.
"There are much higher concentrations of poverty in these regions, and there is a direct correlation between all kinds of chronic disease and poverty," Wilhide says.
Rosemary McKenzie, minority affairs director for the association, says cultural barriers also contribute. Many people believe the only time you go to the doctor is when you're very, very ill and all other home remedies have failed, she explains.
Cancer in particular is seen as a death sentence. "They think, 'I'm going to die anyway so I don't want to know that I have it,'" McKenzie says.
"Especially in the deep South, you have people that are illiterate. Some don't believe in modern medicine. They believe in a lot of old folk home remedies. Providers have to take the religious and cultural factors into account or I don't think we're going to make a dent."
Educational efforts to teach people about the importance of early cancer detection are important, Wilhide says, but so is funding for free or low-cost screenings.
"Doing preventive health education is important, but it can be like having a library card and no books in the library," he says. "If people can't afford the health care, they're not going to get it."
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