Breast and cervical carcinoma: the correlation of activity limitations and rurality with screening, disease incidence, and mortality.
BACKGROUND
Although screening for breast and cervical carcinoma has been widely accepted as beneficial, specific segments of the population are not receiving these services as frequently as recommended. The objective of this study was to describe differences in breast and cervical screening prevalence among those with activity limitations and those residing in rural areas. Disparities in the incidence rates of in situ breast carcinoma and cervical carcinoma, as well as mortality among rural and urban women, are also described.


METHODS
Data from the Iowa Behavioral Risk Factor Surveillance System (BRFSS) and Iowa's Surveillance, Epidemiology, and End Results (SEER) were used to determine the prevalence of screening and adverse outcomes among rural populations. To describe the rural nature of counties, the authors used the number of residents per square mile for each county and classified the results into five groups. Mulitple logistic regression was used to determine the prevalence of screening among those with activity limitations and rural residents.


RESULTS
Using the BRFSS, those with activity limitations and those residing in rural Iowa were less likely screened for breast or cervical carcinoma. This translated into a lower in situ breast carcinoma incidence rate and a higher invasive cervical carcinoma incidence rate among rural women relative to their urban counterparts. No differences were found for mortality from these cancers.


CONCLUSIONS
Lower screening prevalence among rural residents translated into adverse health outcomes. Interventions for increasing the frequency of screening are described.
Schootman
M
M
Bureaus of Health Promotion and Disability Prevention, Iowa Department of Public Health, Des Moines, Iowa, USA.
Fuortes
L J
LJ
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000401:mortality; D002278:Carcinoma in Situ / Q000453:epidemiology* / Q000401:mortality; D006233:Persons with Disabilities; D005260:Female; D006801:Humans; D015994:Incidence; D007407:Interviews as Topic; D007484:Iowa; D008403:Mass Screening; D008875:Middle Aged; D012424:Rural Population; D018426:SEER Program; D013689:Telephone; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000401:mortality