Abstract PO-266: Rural-Urban differences in breast and colorectal cancer screening among United States females: 2014-2019
Authors: Theodoropoulos Nicholas , Xie Hui , Wang Qian , Li Yannan 
Published: January 2022

Abstract
Background: Previous literature has revealed rural residents lagged behind their urban counterparts in colorectal cancer (CRC) and breast cancer screening. Between 2013 and 2017, 64 rural hospitals closed, which was double the amount in the preceding 5 years and consisted of 3% of all rural hospitals. Rural residents reported having to skip diagnostic imaging and preventative care due to local hospital closures. In light of continued rural hospital closures, this study aimed to further examine the trends and correlates of breast and colorectal cancer screening among females aged 50-74. Methods: This cross-sectional study analyzed the nationally representative datasets from the Behavioral Risk Factor Surveillance System (BRFSS) data available between 2014-2019. Focusing on females aged 50-74, we evaluated prevalence of breast and colorectal cancer screening overall and by urban-rural locations using multivariate logistic regression, adjusting for confounders including demographic, socioeconomic and behavioral factors. Results: This study included 255,737 urban and 127,810 rural residents. In total, urban areas have higher rates of breast (79.85% vs.74.97%; p&lt;0.001) and colorectal (75.31% vs. 68.82%; p&lt;0.001) cancer screenings. Between 2014 and 2019 the urban-rural difference in mammography has reduced with no significant difference between urban and rural residents in 2019 (82.78% vs 81.59%; p=0.710). A similar trend was seen in colonoscopy use however the difference remains significant in 2019 (81.20% urban vs 76.92% rural; p=0.046). Colorectal and breast cancer screening was associated with residential areas, race/ethnicity, and sexual orientation after adjusting for age, education, income, marital status, general health, checkup, health insurance, medical cost, smoking status, and binge drinking. Rural females were almost 10% less likely to have mammogram screening than urban counterparts (p&lt;0.001). Non-Hispanic blacks (NHB), Asian, and Hispanic were 1.84, 1.22, and 1.36 times more likely to have mammogram screenings compared to their non-Hispanic white (NHW) peers respectively (p&lt;0.001, p=0.011, &lt;0.001). In addition, bisexual females were 24% less likely to have a mammogram than heterosexual/straight-identified females (p=0.003). In regard to colonoscopy, rural females were 16% less likely to have a colonoscopy than urban females (p&lt;0.001). NHB were 1.3 times more likely to have a screening colonoscopy compared to their NHW peers (p&lt;0.001). Lesbians were 1.3 times more likely to have a colonoscopy than heterosexuals (p&lt;0.001). Conclusions: Disparities remain in CRC and breast cancer screening between urban and rural females. Our findings underline the importance of improving health access and cancer prevention in rural female Americans, a population characterized by a lower socioeconomic status, poor health literacy and lack of health access. Tailored geographic-based cancer prevention programs should be considered in addressing these disparities.
Citation Format: Nicholas Theodoropoulos, Hui Xie, Qian Wang, Yannan Li. Rural-Urban differences in breast and colorectal cancer screening among United States females: 2014-2019 [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-266.