title: Variability of cervical cancer rates across 5 Appalachian states, 1998-2003.
abstract: BACKGROUND
  Although the rates of invasive cervical cancer (ICC) have decreased substantially in the US since the advent of the Papanicolaou (Pap) test, Appalachian women remain at increased risk compared with the nation as a whole. The ICC incidence rates were compared in 5 Appalachian states with population-based cancer registries to investigate variability within the Appalachian region.
  
  
  METHODS
  Alabama, Kentucky, Ohio, Pennsylvania, and West Virginia were selected for the analysis on the basis of their having high-quality cancer registry data for 1998 through 2003. Incidence rates were calculated by state and by Appalachia/non-Appalachia, urban/rural, and black/nonblack within each state, following the standard case definition and inclusion criteria used in this supplement. Data from the Behavioral Risk Factor Surveillance System (BRFSS) were used to characterize the prevalence of Pap testing and smoking.
  
  
  RESULTS
  The ICC incidence rates varied among the 5 states, being highest in West Virginia (10.9 of 100,000) and Kentucky (10.7 of 100,000), and lowest in Ohio (8.2 of 100,000). The Appalachian regions of Kentucky, West Virginia, and Ohio had considerably higher rates than those of Alabama and Pennsylvania. These variations reflected patterns in the rates of poverty, education, smoking, and Pap testing.
  
  
  CONCLUSIONS
  The variability in ICC risk across subgroups of Appalachia should be considered in the planning of preventive strategies, including reduction in risk factors and promotion of screening and vaccination.
authors.affiliation: Markey Cancer Control Program, Lexington, Kentucky, USA. cmhope0@uky.edu
authors.forename: Claudia
authors.initials: C
authors.lastname: Hopenhayn
authors.forename: Jessica B
authors.initials: JB
authors.lastname: King
authors.forename: Amy
authors.initials: A
authors.lastname: Christian
authors.forename: Bin
authors.initials: B
authors.lastname: Huang
authors.forename: W Jay
authors.initials: WJ
authors.lastname: Christian
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000407:Alabama / Q000453:epidemiology; D001061:Appalachian Region / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007629:Kentucky / Q000453:epidemiology; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D010414:Pennsylvania / Q000453:epidemiology; D012042:Registries; D012907:Smoking; D012959:Socioeconomic Factors; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology*; D014903:West Virginia / Q000453:epidemiology