title: Diabetes and cancer screening rates among Appalachian and non-Appalachian residents of Kentucky.
abstract: BACKGROUND
  Having diabetes may increase the odds of late-stage breast cancer. In Kentucky, the rates of late-stage disease are higher in rural than in urban areas, particularly in rural Appalachia. The objectives of the study were to examine the relationship between diabetes and cancer screening and to determine whether Appalachia residence modifies this association.
  
  
  METHODS
  One thousand thirty Kentucky adults responded to a 2008 telephone survey that measured whether they had diabetes; lived in Appalachia; had guideline-concordant screening for breast (mammogram, clinical breast examination), cervical (Papanicolaou), and colorectal (fecal occult blood test or sigmoidoscopy/colonoscopy) cancer; and whether they reported receiving mammograms regularly every 1 to 2 years.
  
  
  RESULTS
  Of the subjects, 16% had diabetes, 21% were Appalachian, and 32% were men. In multivariate analysis, women with diabetes had about half the odds of "regular" mammography screening (odds ratio, 0.56) compared with those without diabetes. Men and women in Appalachia had about half the odds of colonoscopy or sigmoidoscopy within the past 10 years (odds ratio, 0.54) compared with those living outside Appalachia.
  
  
  CONCLUSIONS
  Both having diabetes and living in Appalachia were negatively associated with current and regular cancer screening. Less screening may explain late-stage diagnosis among these populations.
authors.affiliation: Departments of Epidemiology and Family and Community Medicine, University of Kentucky, Lexington, KY 40536, USA. stflem2@uky.edu
authors.forename: Steven T
authors.initials: ST
authors.lastname: Fleming
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Love
authors.forename: Keisa
authors.initials: K
authors.lastname: Bennett
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001061:Appalachian Region / Q000453:epidemiology; D001943:Breast Neoplasms / Q000175:diagnosis*; D003113:Colonoscopy / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000175:diagnosis*; D003920:Diabetes Mellitus / Q000453:epidemiology; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D006306:Health Surveys; D006801:Humans; D007629:Kentucky / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008327:Mammography / Q000706:statistics & numerical data; D008875:Middle Aged; D065006:Papanicolaou Test; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012812:Sigmoidoscopy / Q000706:statistics & numerical data; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears / Q000706:statistics & numerical data